NPI | 1144479197 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CO CSW.09924412) |
Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) |
Enumeration Date | 2008-09-15 |
Last Update Date | 2021-07-16 |