| NPI | 1598294365 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C012315) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC LCAS-23965) |
| 1041C0700X Social Worker, Clinical (Licence: NC P011574) | |
| 175T00000X Peer Specialist | |
| Enumeration Date | 2017-06-06 |
| Last Update Date | 2023-03-02 |