NPI | 1689975633 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OR L5227) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 97-04-19) |
104100000X Social Worker (Licence: OR A2316) | |
Enumeration Date | 2010-11-08 |
Last Update Date | 2025-05-30 |