NPI | 1457731655 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101Y00000X Counselor |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: 17-R-39) |
104100000X Social Worker | |
171M00000X Case Manager/Care Coordinator | |
Enumeration Date | 2015-06-02 |
Last Update Date | 2021-06-03 |