| NPI | 1013275544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: ID LCSW-36921) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: ID LCSW-36921) |
| 104100000X Social Worker (Licence: ID LMSW-32118) | |
| Enumeration Date | 2012-05-03 |
| Last Update Date | 2022-05-09 |