| NPI | 1033102264 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NE 1252) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NE 522) |
| 101YM0800X Counselor, Mental Health (Licence: NE 3279) | |
| 104100000X Social Worker (Licence: NE 1252) | |
| 1041S0200X Social Worker, School | |
| Enumeration Date | 2005-08-23 |
| Last Update Date | 2022-01-31 |