| NPI | 1598061335 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NM C-08875) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NM 0129141) |
| 104100000X Social Worker (Licence: NM X-07222) | |
| Enumeration Date | 2011-01-26 |
| Last Update Date | 2016-02-24 |