| NPI | 1699399071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NM M-11126) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NM M11126) |
| Enumeration Date | 2020-06-02 |
| Last Update Date | 2021-03-03 |