| NPI | 1922401918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: WI 8628) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 17183) |
| 1041C0700X Social Worker, Clinical (Licence: WI 129527) | |
| Enumeration Date | 2014-10-03 |
| Last Update Date | 2021-11-11 |