| NPI | 1720611775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: GA CSW007990) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: GA MSW008424) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: GA CSW007990) | |
| 101YM0800X Counselor, Mental Health (Licence: GA MSW008424) | |
| 1041C0700X Social Worker, Clinical (Licence: GA CSW007990) | |
| Enumeration Date | 2020-02-18 |
| Last Update Date | 2022-08-25 |