NPI | 1124534821 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 104100000X Social Worker (Licence: IL 150.101672) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IL 32995) |
Enumeration Date | 2017-12-18 |
Last Update Date | 2017-12-18 |