| NPI | 1750040556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 23-CRM-2187) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OR 22-QMHA-R-3173) |
| 175T00000X Peer Specialist (Licence: OR THW000107157) | |
| Enumeration Date | 2021-12-09 |
| Last Update Date | 2024-06-14 |