NPI | 1558462481 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149010487) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO LAC 127) |
1041C0700X Social Worker, Clinical (Licence: CO CSW 434) | |
Enumeration Date | 2006-09-25 |
Last Update Date | 2025-09-11 |