| NPI | 1457683666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: SC 11510) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: SC 17051511) |
| Enumeration Date | 2010-02-12 |
| Last Update Date | 2018-07-09 |