| NPI | 1508096397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OR L4472) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 08-R-15) |
| 1041C0700X Social Worker, Clinical (Licence: WA LW61056314) | |
| Enumeration Date | 2009-07-15 |
| Last Update Date | 2021-10-06 |