| NPI | 1811238587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 97416) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 14357) |
| 1041C0700X Social Worker, Clinical (Licence: TX 60924) | |
| 1041C0700X Social Worker, Clinical (Licence: VT 089.0134242) | |
| Enumeration Date | 2013-03-06 |
| Last Update Date | 2023-12-15 |