| NPI | 1235488263 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OR L7660) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 101YM0800X Counselor, Mental Health | |
| 104100000X Social Worker (Licence: 0) | |
| Enumeration Date | 2012-09-06 |
| Last Update Date | 2019-07-12 |