| NPI | 1033485768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: FL sw00005348) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL CAP 1466) |
| Enumeration Date | 2012-03-27 |
| Last Update Date | 2012-03-27 |