| NPI | 1851657605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 15-02-18) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OR 19-QMHA-I-00020) |
| Enumeration Date | 2012-04-05 |
| Last Update Date | 2021-03-17 |