| NPI | 1992262067 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OR R8747) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR T-24-3960) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NE P-1905) | |
| 101YM0800X Counselor, Mental Health (Licence: NE 12710) | |
| Enumeration Date | 2019-02-25 |
| Last Update Date | 2024-06-04 |