NPI | 1629510987 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IA 072294) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IA 14107) |
Enumeration Date | 2016-11-17 |
Last Update Date | 2016-11-17 |