| NPI | 1932566817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: SC 10285) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: 10285) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: SC 152012) | |
| 104100000X Social Worker (Licence: SC 10285) | |
| Enumeration Date | 2016-01-22 |
| Last Update Date | 2020-04-22 |