| NPI | 1255371142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 13018) |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2014-12-19 |