NPI | 1942663968 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 104100000X Social Worker (Licence: OR A13390) |
Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: OR QMHP) |
101YA0400X Counselor Addiction (Substance Use Disorder) | |
101YM0800X Counselor Mental Health (Licence: OR 19-QMHPC-00526) | |
Enumeration Date | 2016-03-29 |
Last Update Date | 2023-03-28 |