| NPI | 1467885350 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OR L8588) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 13-06-43) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 17-09-14) | |
| Enumeration Date | 2013-08-14 |
| Last Update Date | 2023-05-05 |