| NPI | 1841851508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: HI LCSW-5235) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OR L11132) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| 104100000X Social Worker (Licence: OR L11132) | |
| Enumeration Date | 2019-06-24 |
| Last Update Date | 2024-12-09 |