| NPI | 1477709228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: IA 007136) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IA 00076) |
| Enumeration Date | 2008-08-13 |
| Last Update Date | 2017-02-13 |