| NPI | 1346292885 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: HI LCSW3051) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: FL 4031CAP) |
| 1041C0700X Social Worker Clinical (Licence: SC 5815) | |
| 1041C0700X Social Worker Clinical (Licence: TX 41718) | |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2012-10-18 |