| NPI | 1851743769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CO 09928070) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC 25513) |
| 101YM0800X Counselor, Mental Health | |
| 1041C0700X Social Worker, Clinical (Licence: NC P013347) | |
| Enumeration Date | 2016-07-05 |
| Last Update Date | 2022-07-28 |