| NPI | 1558031211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC P017910) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NC P017910) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC 28395) | |
| 104100000X Social Worker | |
| Enumeration Date | 2021-09-15 |
| Last Update Date | 2022-08-11 |