| NPI | 1821458019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OR C7483) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OR C7483) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 11-03-51) | |
| Enumeration Date | 2016-03-01 |
| Last Update Date | 2025-03-25 |