NPI | 1215085600 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: KY 1498) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: KY ADCLAD0022409) |
104100000X Social Worker (Licence: KY 1498) | |
Enumeration Date | 2007-01-08 |
Last Update Date | 2019-04-25 |