| NPI | 1730493347 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW11501) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL MCAP100113) |
| 1041C0700X Social Worker, Clinical (Licence: IN 34006025A) | |
| Enumeration Date | 2010-08-06 |
| Last Update Date | 2023-03-23 |