| NPI | 1336646561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: KY 255585) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: KY 173732) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MA 21240) | |
| 1041C0700X Social Worker, Clinical (Licence: MA 124424) | |
| 1041C0700X Social Worker, Clinical (Licence: TN 7555) | |
| Enumeration Date | 2018-04-13 |
| Last Update Date | 2024-03-19 |