| NPI | 1780121046 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NM C-11047) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NM 0176141) |
| 104100000X Social Worker (Licence: NM M-09715) | |
| 104100000X Social Worker (Licence: NM X-11195) | |
| Enumeration Date | 2017-01-25 |
| Last Update Date | 2019-11-19 |