| NPI | 1144377177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: WI 533-123) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: WI 275) |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2008-06-30 |