| NPI | 1699953158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: AK CSWS381) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NC C005914) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| Enumeration Date | 2008-02-07 |
| Last Update Date | 2017-03-15 |