| NPI | 1447901384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OR A14510) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR T-22-1368) |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2022-01-12 |
| Last Update Date | 2024-01-11 |