| NPI | 1811053523 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 07-09-72U3) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OR C1972) |
| 101YP2500X Counselor, Professional (Licence: OR C1972) | |
| 101Y00000X Counselor (Licence: OR C1972) | |
| Enumeration Date | 2006-12-28 |
| Last Update Date | 2024-01-17 |