| NPI | 1093278673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CO 09927412) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CO 0009921601) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO 0001731) | |
| Enumeration Date | 2019-04-10 |
| Last Update Date | 2021-07-26 |