| NPI | 1669161014 |
|---|---|
| Other Name | SAM ALLEN TUCKWIN |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OR 23-QMHP-R-2293) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR T-24-3972) |
| Enumeration Date | 2023-05-02 |
| Last Update Date | 2024-06-14 |