NPI | 1346465267 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 264436-3501) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: UT 264436-3501) |
101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: UT 27813) | |
Enumeration Date | 2007-04-16 |
Last Update Date | 2019-08-02 |