| NPI | 1710130208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OR C3149) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 99-07-07) |
| Enumeration Date | 2008-10-28 |
| Last Update Date | 2019-02-27 |