| NPI | 1093230633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NC C012266) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NC 22879) |
| 1041C0700X Social Worker Clinical (Licence: NC P010415) | |
| Enumeration Date | 2017-08-04 |
| Last Update Date | 2021-06-11 |