| NPI | 1497005250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW12431) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL SW12431) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OK 9107) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: UT 13684367-3501) | |
| 1041C0700X Social Worker, Clinical (Licence: OK 9107) | |
| 1041C0700X Social Worker, Clinical (Licence: TX 111164) | |
| 1041C0700X Social Worker, Clinical (Licence: UT 13684367-3501) | |
| Enumeration Date | 2012-09-19 |
| Last Update Date | 2025-08-06 |