| NPI | 1821431099 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: WI 10068-123) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: WI 15877-131) |
| 104100000X Social Worker (Licence: WI 131735-121) | |
| Enumeration Date | 2013-04-08 |
| Last Update Date | 2022-10-25 |