| NPI | 1932327582 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WI 9829) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 1611) |
| 101YM0800X Counselor, Mental Health (Licence: WI 131515) | |
| Enumeration Date | 2007-04-20 |
| Last Update Date | 2022-11-01 |