| NPI | 1033284229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: NM I0879) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OK 348) |
| Enumeration Date | 2006-11-22 |
| Last Update Date | 2013-03-21 |