| NPI | 1013447309 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OR L8595) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 19-07-07) |
| 101YM0800X Counselor, Mental Health (Licence: OR A4926) | |
| Enumeration Date | 2017-06-19 |
| Last Update Date | 2025-02-24 |