| NPI | 1396180766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: WI 13897) |
| Additional Taxonomies | 104100000X Social Worker (Licence: WI 3574) |
| Enumeration Date | 2013-04-30 |
| Last Update Date | 2017-11-21 |