| NPI | 1649711243 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: SC 16580) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 1041C0700X Social Worker, Clinical (Licence: FL TPSW3939) | |
| 1041C0700X Social Worker, Clinical (Licence: SC 11849) | |
| Enumeration Date | 2017-03-15 |
| Last Update Date | 2024-11-27 |