| NPI | 1275269920 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NC P018008) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NC LCAS-28354) |
| Enumeration Date | 2022-07-26 |
| Last Update Date | 2022-11-30 |