| NPI | 1962840389 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OR C4722) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 12-06-17) |
| Enumeration Date | 2013-06-07 |
| Last Update Date | 2020-04-21 |