| NPI | 1245259886 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OR L2459) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 101Y00000X Counselor | |
| 101YP2500X Counselor, Professional | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2010-07-16 |