| 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 |