| NPI | 1124182126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 1364) |
| Additional Taxonomies | 104100000X Social Worker (Licence: WI 127730) |
| Enumeration Date | 2006-12-21 |
| Last Update Date | 2011-06-20 |