| NPI | 1356402135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NC C004949) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NC LCAS 1549) |
| 101YM0800X Counselor Mental Health (Licence: NC LCSW C004949) | |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2020-11-16 |