| NPI | 1366713075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OR 7785) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 16-05-19) |
| 171M00000X Case Manager/Care Coordinator | |
| 1041C0700X Social Worker, Clinical (Licence: OR L7785) | |
| Enumeration Date | 2012-01-26 |
| Last Update Date | 2019-08-11 |