| NPI | 1881203628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OR L11639) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR T-20-247) |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2020-07-28 |
| Last Update Date | 2024-04-19 |