| NPI | 1295340156 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OR A13125) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 21R47) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA 196921IV) | |
| 104100000X Social Worker | |
| 1041C0700X Social Worker, Clinical (Licence: CA 96776) | |
| 1041S0200X Social Worker, School (Licence: OR 553664) | |
| 1041S0200X Social Worker, School (Licence: CA 200135836) | |
| Enumeration Date | 2020-09-08 |
| Last Update Date | 2022-03-27 |