| NPI | 1962567479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OR in process) |
| Additional Taxonomies | 376K00000X Nurse's Aide (Licence: OR 000039529CNA) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 01-P-09) | |
| Enumeration Date | 2006-12-26 |
| Last Update Date | 2007-09-12 |