| NPI | 1811261506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR CADC II, 13-12-54) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 101YM0800X Counselor, Mental Health (Licence: OR CADCII: 13-12-54) | |
| Enumeration Date | 2012-02-28 |
| Last Update Date | 2017-04-11 |