| NPI | 1306275243 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: IA 112600) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NE 1101) |
| 104100000X Social Worker (Licence: NE 1594) | |
| 1041C0700X Social Worker Clinical (Licence: NE 1515) | |
| Enumeration Date | 2013-11-01 |
| Last Update Date | 2023-01-09 |