NPI | 1750594594 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CT 8160) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health |
101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CT 830) | |
Enumeration Date | 2007-05-08 |
Last Update Date | 2014-11-24 |