| NPI | 1124250634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OR L6147) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR L6147) |
| 101YM0800X Counselor, Mental Health (Licence: OR L6147) | |
| 101YP2500X Counselor, Professional (Licence: OR L6147) | |
| 106H00000X Marriage & Family Therapist (Licence: OR L6147) | |
| Enumeration Date | 2009-08-17 |
| Last Update Date | 2014-09-21 |