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 |