| NPI | 1295836567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: WI 1783-123) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 1521) |
| 1041C0700X Social Worker, Clinical (Licence: WI 1783-123) | |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2015-05-21 |