| NPI | 1245611359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NH 2583) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NH 0583) | |
| Enumeration Date | 2015-06-15 |
| Last Update Date | 2022-07-29 |