| NPI | 1861205213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR T-24-3581) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 24-CRM-II-0306) |
| Enumeration Date | 2025-01-29 |
| Last Update Date | 2025-03-06 |