| NPI | 1447553557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WI 7691125) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 15785) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 3671-226) | |
| 104100000X Social Worker (Licence: WI 7691) | |
| Enumeration Date | 2010-12-10 |
| Last Update Date | 2024-10-17 |