NPI | 1568749687 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: OR 5447) |
Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) |
101YM0800X Counselor Mental Health | |
Enumeration Date | 2011-11-03 |
Last Update Date | 2022-05-06 |