| NPI | 1235533308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 04-07-26) |
| 1041C0700X Social Worker, Clinical (Licence: OR L8062) | |
| Enumeration Date | 2014-10-17 |
| Last Update Date | 2020-07-08 |