| NPI | 1699968701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 070621) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OR 10016625) |
| Enumeration Date | 2007-08-22 |
| Last Update Date | 2023-10-24 |