| NPI | 1134147374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: LA 23) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: LA 3) |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: LA 478) | |
| 1041C0700X Social Worker Clinical (Licence: LA 6111) | |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2007-07-08 |