| NPI | 1043633159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WI 8083-123) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 15662-131) |
| Enumeration Date | 2014-01-24 |
| Last Update Date | 2015-03-25 |