| NPI | 1063765816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: CA 081732-II) |
| Enumeration Date | 2012-10-17 |
| Last Update Date | 2018-03-02 |