NPI | 1770113060 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CO 09929352) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO 2221) |
175T00000X Peer Specialist | |
Enumeration Date | 2020-01-25 |
Last Update Date | 2023-06-08 |