| NPI | 1194854786 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 101YM0800X Counselor, Mental Health (Licence: OR 1490) | |
| 106H00000X Marriage & Family Therapist | |
| Enumeration Date | 2007-03-02 |
| Last Update Date | 2014-09-18 |