| NPI | 1194014522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CO 1812) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 9371) |
| 101YP2500X Counselor, Professional (Licence: TX 10669) | |
| 1041C0700X Social Worker, Clinical (Licence: TX 12082) | |
| 171M00000X Case Manager/Care Coordinator (Licence: NJ 4213779) | |
| Enumeration Date | 2011-04-06 |
| Last Update Date | 2019-09-06 |