| NPI | 1447688171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL ISW 7418) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL 4706) |
| 1041C0700X Social Worker, Clinical (Licence: FL LCSW 13798) | |
| Enumeration Date | 2013-10-15 |
| Last Update Date | 2017-04-20 |