| NPI | 1669740007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OR 05/07/24) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: OR 23-QMHA-R-4172) |
| Enumeration Date | 2011-12-13 |
| Last Update Date | 2023-08-14 |