| NPI | 1730850967 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: NC P016658) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC 27379) |
| Enumeration Date | 2021-09-27 |
| Last Update Date | 2021-09-27 |