| NPI | 1659517837 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: NC C007062) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CO CSW.09926354) |
| 1041C0700X Social Worker, Clinical (Licence: NC P-0004680) | |
| 1041C0700X Social Worker, Clinical (Licence: NC C 007062) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC P004680) | |
| Enumeration Date | 2008-12-18 |
| Last Update Date | 2025-08-29 |