| NPI | 1275803033 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OR L5845) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 11-06-53) | |
| 104100000X Social Worker (Licence: OR A2822) | |
| Enumeration Date | 2012-01-10 |
| Last Update Date | 2013-06-19 |