| NPI | 1720232499 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 08-12-37) |
| Additional Taxonomies | 172V00000X Community Health Worker (Licence: OR 8086) |
| Enumeration Date | 2008-11-07 |
| Last Update Date | 2023-03-09 |