| NPI | 1861840621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR CADC I 160413) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR CADCI 16-04-13) |
| Enumeration Date | 2016-06-01 |
| Last Update Date | 2016-06-01 |