| NPI | 1386292126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OR L14757) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 23-R-44) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO ACD.0002319) | |
| 1041C0700X Social Worker, Clinical (Licence: WA LW.61489680) | |
| 1041C0700X Social Worker, Clinical (Licence: CO CSW.099270069) | |
| 1041C0700X Social Worker, Clinical (Licence: TX 113863) | |
| Enumeration Date | 2019-08-26 |
| Last Update Date | 2024-07-26 |