NPI | 1922023621 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: AZ 4026LCSW) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: AZ 11050) |
Enumeration Date | 2006-07-13 |
Last Update Date | 2020-09-25 |