| 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 |