| NPI | 1689120966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC LCASA-23024) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC CSAC-15285) |
| 1041C0700X Social Worker, Clinical (Licence: NC P010667) | |
| Enumeration Date | 2016-08-28 |
| Last Update Date | 2016-08-28 |