| NPI | 1811951569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: OR L3658) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OR 031171) |
| Enumeration Date | 2006-04-12 |
| Last Update Date | 2022-01-06 |