| NPI | 1881084887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OR 07-06-16) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: OR 11-CRM-145) |
| Enumeration Date | 2015-01-28 |
| Last Update Date | 2015-01-28 |