| NPI | 1750774048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: OR C5095) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OR 15-05-06) |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OR 18-02-29) | |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2015-03-10 |
| Last Update Date | 2023-01-14 |