| NPI | 1144831991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OR A14900) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 25-05-30158) |
| 101YM0800X Counselor, Mental Health (Licence: OR 24-QMHPC-001493) | |
| Enumeration Date | 2020-08-14 |
| Last Update Date | 2025-05-29 |