| NPI | 1831537422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OR L5541) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 14-02-01) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 17-06-18) | |
| 104100000X Social Worker (Licence: CA 14564) | |
| Enumeration Date | 2013-06-05 |
| Last Update Date | 2019-08-07 |