| NPI | 1013078518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: WI 3457) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: WI 11162) |
| 1041C0700X Social Worker Clinical (Licence: WI 3457-123) | |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2012-08-09 |