| NPI | 1306242458 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MS C7217) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MS M7217) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MS AD07-046M) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-11-17 |
| Last Update Date | 2023-09-11 |