| NPI | 1346474715 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: WI 1127123) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: WI 1467132) |
| 101YP2500X Counselor Professional (Licence: WI 334125) | |
| Enumeration Date | 2009-05-13 |
| Last Update Date | 2009-05-13 |