| NPI | 1760932735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NH 1962) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NH 0556) |
| 1041S0200X Social Worker School (Licence: MN 27853) | |
| Enumeration Date | 2016-10-13 |
| Last Update Date | 2021-07-01 |