| NPI | 1013189257 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: GA MSW003688) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: GA MSW003688) |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: GA MSW003688) | |
| 101YM0800X Counselor Mental Health (Licence: GA MSW003688) | |
| 101YP2500X Counselor Professional (Licence: GA MSW00368) | |
| 1041C0700X Social Worker Clinical (Licence: GA MSW003688) | |
| Enumeration Date | 2008-03-27 |
| Last Update Date | 2008-03-27 |