| NPI | 1689792947 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NM M-07294) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NM 0103951) |
| 1041C0700X Social Worker, Clinical (Licence: NM C-08275) | |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2021-07-01 |