NPI | 1336294461 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NV 7769-C) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MA 13320) |
1041C0700X Social Worker, Clinical (Licence: MA 120382) | |
Enumeration Date | 2007-01-25 |
Last Update Date | 2018-01-04 |