| NPI | 1811562739 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: WI 11279-123) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: WI 19383-130) |
| 1041C0700X Social Worker Clinical (Licence: WI 132348) | |
| Enumeration Date | 2021-05-24 |
| Last Update Date | 2023-05-23 |