| NPI | 1255607016 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: KS 8190) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: KS 707) |
| Enumeration Date | 2012-03-27 |
| Last Update Date | 2012-04-11 |