| NPI | 1376886978 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: FL SW11487) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: FL SW11487) |
| 102L00000X Psychoanalyst (Licence: FL SW11487) | |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: FL SW11487) | |
| 104100000X Social Worker (Licence: FL SW11487) | |
| Enumeration Date | 2013-04-02 |
| Last Update Date | 2013-09-26 |