| NPI | 1366654139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WV BP00943419) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WV 06-111) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WV 112279) | |
| Enumeration Date | 2007-05-04 |
| Last Update Date | 2009-07-13 |