| NPI | 1194726794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VA 0904010218) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 104100000X Social Worker (Licence: KS 1897) | |
| 1041C0700X Social Worker, Clinical (Licence: TX 29983) | |
| 376K00000X Nurse's Aide (Licence: VA 1401142966) | |
| Enumeration Date | 2005-08-03 |
| Last Update Date | 2022-04-28 |