| NPI | 1699854166 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TN 3661) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TN TN-048) |
| 1041C0700X Social Worker, Clinical (Licence: AR 1939-c) | |
| Enumeration Date | 2006-11-03 |
| Last Update Date | 2023-02-22 |