| NPI | 1073868055 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YA0400X Counselor Addiction (Substance Use Disorder) | |
| 1041C0700X Social Worker Clinical | |
| 1041S0200X Social Worker School | |
| Enumeration Date | 2012-07-17 |
| Last Update Date | 2012-07-17 |