| NPI | 1700466117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WI 9983-123) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 19344-130) |
| 104100000X Social Worker (Licence: WI 131900-121) | |
| Enumeration Date | 2021-04-09 |
| Last Update Date | 2023-09-26 |