| NPI | 1285916155 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: NC C008971) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC C008971) |
| 1041C0700X Social Worker, Clinical (Licence: NC C008971) | |
| Enumeration Date | 2011-09-15 |
| Last Update Date | 2024-07-15 |