| NPI | 1699216580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WI 1883) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 12601) |
| 101YP2500X Counselor, Professional (Licence: WI 278) | |
| Enumeration Date | 2017-03-13 |
| Last Update Date | 2017-03-13 |