| NPI | 1487391892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC P018025) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC LCAS-28363) |
| 1041C0700X Social Worker, Clinical | |
| Enumeration Date | 2022-05-17 |
| Last Update Date | 2022-08-11 |