| NPI | 1336294461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NV 7769-C) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MA 13320) |
| 1041C0700X Social Worker, Clinical (Licence: MA 120382) | |
| Enumeration Date | 2007-01-25 |
| Last Update Date | 2018-01-04 |