| NPI | 1538791181 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: ID 33482) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: ID 11416) |
| Enumeration Date | 2020-02-11 |
| Last Update Date | 2020-02-11 |