| NPI | 1598801292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OR L5128) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OR MSW) |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2026-03-04 |