| NPI | 1427355445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WI 7567-123) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 15331-132) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 15412-133) | |
| Enumeration Date | 2011-02-28 |
| Last Update Date | 2025-06-26 |