| NPI | 1023295417 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: NC C005939) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NC 1957) |
| Enumeration Date | 2008-01-28 |
| Last Update Date | 2023-10-25 |