| NPI | 1235214024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OH I0600061) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: HI 1183-03R) |
| 101YP2500X Counselor, Professional (Licence: IL 180-004212) | |
| Enumeration Date | 2006-10-27 |
| Last Update Date | 2008-07-28 |