| NPI | 1235295155 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MA 1199) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MA 3032220) |
| Enumeration Date | 2006-12-28 |
| Last Update Date | 2015-12-30 |