| NPI | 1699182733 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 13-09-02) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OR 15-PRC-009) |
| Enumeration Date | 2014-07-21 |
| Last Update Date | 2016-02-02 |