| NPI | 1568836708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: OR 6613) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OR 10-09-59) |
| Enumeration Date | 2015-11-27 |
| Last Update Date | 2015-11-27 |