| NPI | 1174540009 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: CO 991320) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO 2049) |
| Enumeration Date | 2006-07-16 |
| Last Update Date | 2016-08-17 |