| NPI | 1720667702 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: OR 23-QMHA-I-003747) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 23-05-20277) |
| Enumeration Date | 2021-04-06 |
| Last Update Date | 2025-04-21 |