| NPI | 1982221933 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WI 11205-123) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 19314-130) |
| 1041C0700X Social Worker, Clinical (Licence: WI 132396-121) | |
| Enumeration Date | 2020-06-25 |
| Last Update Date | 2024-08-15 |