| NPI | 1467043513 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OR L16621) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 23-11-10964) |
| Enumeration Date | 2021-02-01 |
| Last Update Date | 2025-06-30 |