| NPI | 1265072326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: SW16948) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 101YM0800X Counselor, Mental Health | |
| 1041S0200X Social Worker, School (Licence: SW16948) | |
| Enumeration Date | 2020-01-07 |
| Last Update Date | 2023-02-26 |