| NPI | 1487930210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: CA ASW22325) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NV 00648) |
| Enumeration Date | 2011-10-25 |
| Last Update Date | 2011-10-25 |