| NPI | 1952521775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MT 934) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MT 1193) |
| 101YM0800X Counselor, Mental Health (Licence: MT 548) | |
| Enumeration Date | 2007-04-26 |
| Last Update Date | 2018-11-14 |