| NPI | 1437160447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 2087) |
| Additional Taxonomies | 104100000X Social Worker (Licence: WI 1583-120) |
| Enumeration Date | 2006-08-11 |
| Last Update Date | 2013-04-15 |