| NPI | 1326582305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WI 8941-123) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 17824-130) |
| 1041C0700X Social Worker, Clinical (Licence: WI 130440-121) | |
| Enumeration Date | 2016-12-12 |
| Last Update Date | 2022-06-20 |