| NPI | 1780008268 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: TN 1258) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC LCAS-20752) |
| 1041C0700X Social Worker, Clinical (Licence: NC P008294) | |
| Enumeration Date | 2014-02-05 |
| Last Update Date | 2022-03-25 |