| NPI | 1740558246 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: WA LW60546453) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: NC C008754) |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OR 13-03-35) | |
| Enumeration Date | 2011-12-12 |
| Last Update Date | 2021-06-17 |