| NPI | 1780718718 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OR L7152) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR CADCI 01-07-33) |
| Enumeration Date | 2007-03-14 |
| Last Update Date | 2025-09-20 |