| NPI | 1164002606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC P015924) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC LCAS-16563) |
| 101YM0800X Counselor, Mental Health (Licence: NC P015924) | |
| Enumeration Date | 2021-04-09 |
| Last Update Date | 2021-06-03 |