| NPI | 1972758753 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OR L002041) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OR L002041) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR L002041) | |
| 101YP2500X Counselor, Professional (Licence: OR L002041) | |
| 106H00000X Marriage & Family Therapist (Licence: OR L002041) | |
| Enumeration Date | 2008-11-20 |
| Last Update Date | 2008-11-20 |