| NPI | 1528702818 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OR A14433) |
| Additional Taxonomies | 104100000X Social Worker |
| 101YM0800X Counselor, Mental Health (Licence: OR 23-QMHP-R-2263) | |
| Enumeration Date | 2022-04-23 |
| Last Update Date | 2023-12-05 |