| NPI | 1063882967 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C014392) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC LCAS-23009) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC CSAC-15880) | |
| Enumeration Date | 2015-10-05 |
| Last Update Date | 2024-11-22 |