| NPI | 1083056428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO 627) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CO 9920513) |
| Enumeration Date | 2013-07-26 |
| Last Update Date | 2015-12-28 |