| NPI | 1013099522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OR L7006) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CP00005784) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 16-R-16) | |
| Enumeration Date | 2006-10-20 |
| Last Update Date | 2016-10-10 |