| NPI | 1013447671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: ID LCSW-39053) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: ID ACADC-13016) |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: ID LMSW-36753) | |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: ID LCSW-39053) | |
| 171M00000X Case Manager/Care Coordinator (Licence: ID LCSW-39053) | |
| Enumeration Date | 2017-06-15 |
| Last Update Date | 2021-11-18 |