| NPI | 1265803951 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: WA LW60640057) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: VA 0710102959) |
| 104100000X Social Worker (Licence: VA 0904009189) | |
| 104100000X Social Worker (Licence: TX 63793) | |
| Enumeration Date | 2015-10-07 |
| Last Update Date | 2025-02-01 |