| NPI | 1922631399 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OR 22-10-20209) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OR 19-07-25) |
| 101YM0800X Counselor Mental Health (Licence: OR 22-QMHA-I-003463) | |
| 172V00000X Community Health Worker (Licence: OR THW000107060) | |
| Enumeration Date | 2020-02-13 |
| Last Update Date | 2024-04-08 |