| NPI | 1902272198 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: UT 4920528-3501) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: UT 4920528-6006) |
| 1041C0700X Social Worker Clinical (Licence: WY LCSW-927) | |
| Enumeration Date | 2015-08-11 |
| Last Update Date | 2020-03-02 |