| NPI | 1275725095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MA 152) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MA 4022707) |
| Enumeration Date | 2007-08-15 |
| Last Update Date | 2007-09-12 |