NPI | 1407309503 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: AK 137121) |
Additional Taxonomies | 101Y00000X Counselor |
101YA0400X Counselor, Addiction (Substance Use Disorder) | |
101YM0800X Counselor, Mental Health | |
Enumeration Date | 2016-07-26 |
Last Update Date | 2020-05-01 |