| NPI | 1629216015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NM SWB-2022-0852) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NM 2004) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MI 680108111) | |
| 104100000X Social Worker (Licence: NM SWB-2022-0852) | |
| Enumeration Date | 2009-01-23 |
| Last Update Date | 2023-05-05 |