| NPI | 1003879206 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NH 1745) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MA 2274) |
| 1041C0700X Social Worker, Clinical (Licence: MA 115174) | |
| Enumeration Date | 2006-04-10 |
| Last Update Date | 2020-12-08 |