| NPI | 1770989840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OR 10-03-24) |
| Additional Taxonomies | 320800000X Community Based Residential Treatment Facility, Mental Illness (Licence: OR 10-03-24) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 10-03-24) | |
| Enumeration Date | 2014-11-17 |
| Last Update Date | 2016-07-08 |