| NPI | 1477507838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: MT 951LAC) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: MT 579LCSW) |
| Enumeration Date | 2006-05-20 |
| Last Update Date | 2007-07-08 |