| NPI | 1689975633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 97-04-19) |
| Additional Taxonomies | 104100000X Social Worker (Licence: OR A2316) |
| Enumeration Date | 2010-11-08 |
| Last Update Date | 2010-11-08 |