| NPI | 1902463086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OR L10830) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CP61374175) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 19-10-32) | |
| 1041C0700X Social Worker, Clinical (Licence: WA LW61327515) | |
| Enumeration Date | 2019-05-23 |
| Last Update Date | 2025-04-24 |