| NPI | 1164922092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC CO13725) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC LCAS-24215) |
| 1041C0700X Social Worker, Clinical (Licence: NC QS141061) | |
| Enumeration Date | 2018-02-16 |
| Last Update Date | 2026-04-23 |