| NPI | 1699264184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW17581) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL ADC-009399-2015) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL 804596) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL 16360816) | |
| Enumeration Date | 2018-05-09 |
| Last Update Date | 2026-02-26 |