| NPI | 1326123282 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: WI 972) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: WI 6569) |
| 1041S0200X Social Worker School | |
| Enumeration Date | 2006-10-26 |
| Last Update Date | 2007-07-26 |