| NPI | 1780250043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OR R9017) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 21-03-20036) |
| Enumeration Date | 2021-05-27 |
| Last Update Date | 2024-05-15 |