| NPI | 1588166243 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C013024) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC 23890) |
| 1041C0700X Social Worker, Clinical (Licence: NC PO11867) | |
| Enumeration Date | 2018-03-08 |
| Last Update Date | 2022-11-30 |