| NPI | 1942663968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: OR L30038) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OR 19-QMHPC-00526) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| 101YM0800X Counselor, Mental Health (Licence: OR QMHP) | |
| Enumeration Date | 2016-03-29 |
| Last Update Date | 2025-11-19 |