| NPI | 1639519556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 101YA0400X Counselor Addiction (Substance Use Disorder) | |
| Enumeration Date | 2013-06-25 |
| Last Update Date | 2021-12-17 |