| NPI | 1073756623 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 1541-132) |
| Additional Taxonomies | 104100000X Social Worker (Licence: WI 955-120) |
| Enumeration Date | 2009-04-13 |
| Last Update Date | 2016-06-08 |