| NPI | 1558898809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C012389) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC 23037) |
| 104100000X Social Worker | |
| Enumeration Date | 2017-05-17 |
| Last Update Date | 2020-10-01 |