| NPI | 1821456559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 20-07-07) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: OR 16-CRM-008) |
| Enumeration Date | 2016-02-09 |
| Last Update Date | 2020-08-11 |