| NPI | 1710138318 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 19-P-13) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 11-R-26) | |
| 103K00000X Behavior Analyst | |
| Enumeration Date | 2008-10-01 |
| Last Update Date | 2019-09-27 |