| NPI | 1245554617 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NC C007522) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| 104100000X Social Worker (Licence: NC P-LCSW 05394) | |
| 1041C0700X Social Worker Clinical | |
| Enumeration Date | 2010-03-15 |
| Last Update Date | 2021-01-27 |