| NPI | 1134327075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: OR L4153) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OR 96-10-162) |
| Enumeration Date | 2007-07-03 |
| Last Update Date | 2012-12-18 |