| NPI | 1053449322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C005773) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NM 0067772) |
| 1041C0700X Social Worker, Clinical (Licence: NM I-1128) | |
| Enumeration Date | 2007-03-01 |
| Last Update Date | 2007-08-27 |