| NPI | 1356810337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: AZ 15719) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: AZ 15719) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NV 01724-L) | |
| Enumeration Date | 2018-11-19 |
| Last Update Date | 2024-07-19 |