| NPI | 1922022946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OR L0280) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OR L0280) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR L0280) | |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2014-11-25 |