| NPI | 1063795110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: WI 16394-130) |
| Additional Taxonomies | 104100000X Social Worker |
| Enumeration Date | 2011-09-26 |
| Last Update Date | 2013-02-21 |