| NPI | 1902632151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR T-24-4389) |
| Additional Taxonomies | 172V00000X Community Health Worker (Licence: OR 114306) |
| Enumeration Date | 2024-09-12 |
| Last Update Date | 2025-07-03 |