| NPI | 1801266887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: IN 33006683A) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: KY 172413) |
| 1041C0700X Social Worker, Clinical (Licence: IN 99066837A) | |
| 1041C0700X Social Worker, Clinical (Licence: OH I.1600282.SUPV) | |
| Enumeration Date | 2015-10-02 |
| Last Update Date | 2023-04-17 |