| NPI | 1821331943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 11-06-54) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: OR 20-QMHA-R-0491) |
| Enumeration Date | 2013-03-27 |
| Last Update Date | 2020-07-30 |