| NPI | 1154041523 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC 28472) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC mhl-065-011) |
| 1041C0700X Social Worker, Clinical (Licence: NC P019596) | |
| 1041C0700X Social Worker, Clinical (Licence: NC mhl-065-011) | |
| 171M00000X Case Manager/Care Coordinator (Licence: NC mhl-065-011) | |
| Enumeration Date | 2022-08-29 |
| Last Update Date | 2023-08-24 |