| NPI | 1851684807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 10-12-45) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OR C3388) |
| Enumeration Date | 2011-05-24 |
| Last Update Date | 2015-03-13 |