NPI | 1013447309 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OR L8595) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OR A4926) |
101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 19-07-07) | |
Enumeration Date | 2017-06-19 |
Last Update Date | 2023-08-02 |