| NPI | 1801340021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MD 25040) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MD ADT1177) |
| Enumeration Date | 2016-08-04 |
| Last Update Date | 2023-01-11 |