| NPI | 1750803029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW12702) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: FL SW12702) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL MCAP100135) | |
| 104100000X Social Worker (Licence: FL SW12702) | |
| Enumeration Date | 2017-07-08 |
| Last Update Date | 2022-07-21 |