| NPI | 1821393349 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 07-06-15) |
| Additional Taxonomies | 174400000X Specialist (Licence: OR 09-CPS-004) |
| Enumeration Date | 2011-01-13 |
| Last Update Date | 2011-01-13 |