| NPI | 1841749553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC P010942) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC CSAC-3013) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC LCAS-22847) | |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2016-09-23 |
| Last Update Date | 2016-09-23 |