| NPI | 1518025956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C010128) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: VA 0904010643) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC LCAS-22976) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: VA 0718000684) | |
| 1041C0700X Social Worker, Clinical | |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2025-09-26 |