| NPI | 1477746436 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: IA 02437) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: IA 07030) |
| Enumeration Date | 2007-08-23 |
| Last Update Date | 2010-02-18 |