| NPI | 1982173589 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: OR 21-QMHA-II-000009) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 18-01-43) |
| Enumeration Date | 2018-11-13 |
| Last Update Date | 2025-09-05 |