| NPI | 1982172730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 12-09-43) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OR 19-QMHA-I-00760) |
| 175T00000X Peer Specialist (Licence: OR THW000001281) | |
| 175T00000X Peer Specialist (Licence: OR 11-CRM-070) | |
| Enumeration Date | 2018-11-09 |
| Last Update Date | 2019-04-16 |