| NPI | 1376964106 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NH 1662) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NH 936) |
| Enumeration Date | 2013-12-20 |
| Last Update Date | 2018-08-20 |