| NPI | 1356902886 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NC C014182) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NC LCAS-24750) |
| 104100000X Social Worker (Licence: SC 13077) | |
| 1041C0700X Social Worker Clinical (Licence: NC P013574) | |
| Enumeration Date | 2019-06-25 |
| Last Update Date | 2021-11-01 |