NPI | 1760026058 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC P014169) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC 25636) |
Enumeration Date | 2019-10-30 |
Last Update Date | 2019-10-30 |