| NPI | 1750909172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: GA CSW007918) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CT 1405) |
| 1041C0700X Social Worker, Clinical (Licence: LA 18423) | |
| Enumeration Date | 2020-07-13 |
| Last Update Date | 2024-12-10 |