| NPI | 1659850022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CO 09929056) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA 60880500) |
| 1041C0700X Social Worker, Clinical (Licence: WA 60866107) | |
| Enumeration Date | 2018-08-07 |
| Last Update Date | 2023-03-08 |