NPI | 1780339630 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101Y00000X Counselor (Licence: OR 23-QMHP-R-2326) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR T-22-1847) |
Enumeration Date | 2022-02-18 |
Last Update Date | 2023-09-28 |