| NPI | 1205069242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C007437) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NC P005318) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC 1709) | |
| Enumeration Date | 2009-08-25 |
| Last Update Date | 2014-01-06 |