| NPI | 1033385042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: OR L3873) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OR L3873) |
| 101YM0800X Counselor Mental Health (Licence: OR L3873) | |
| Enumeration Date | 2008-04-30 |
| Last Update Date | 2012-01-27 |