| NPI | 1689346769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR T-21-713) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 20-CRM-280) |
| 101YM0800X Counselor, Mental Health (Licence: OR 21-QMHA-R-1025) | |
| 175T00000X Peer Specialist (Licence: OR THW000104413) | |
| Enumeration Date | 2021-09-28 |
| Last Update Date | 2022-03-17 |