| NPI | 1720004195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 07-06-41) |
| 101YP2500X Counselor, Professional (Licence: OR C4030) | |
| Enumeration Date | 2006-07-15 |
| Last Update Date | 2022-07-21 |