| NPI | 1174816110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OR L6455) |
| Additional Taxonomies | 104100000X Social Worker |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 508391) | |
| Enumeration Date | 2011-05-24 |
| Last Update Date | 2016-10-10 |