| NPI | 1790958973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: WI 3191-123) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: WI 1594-132) |
| 101YP2500X Counselor Professional (Licence: WI 1020) | |
| 101YP2500X Counselor Professional (Licence: WI 1020-125) | |
| 1041C0700X Social Worker Clinical (Licence: WI 3191) | |
| Enumeration Date | 2008-04-08 |
| Last Update Date | 2021-04-19 |