| NPI | 1982043642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 15-04-21) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: OR 24-QMHA-R-4832) |
| 175T00000X Peer Specialist (Licence: OR 23-CRM-2394) | |
| Enumeration Date | 2013-06-17 |
| Last Update Date | 2024-01-19 |