| NPI | 1518436914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: UT 10564656-3502) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: UT 10564656-6018) |
| Enumeration Date | 2018-11-15 |
| Last Update Date | 2020-07-21 |