| NPI | 1265745624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OR L7668) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 09-12-64U) |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2010-07-14 |
| Last Update Date | 2024-04-10 |