| NPI | 1497807796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WI 7590-123) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 16091-130) |
| 1041C0700X Social Worker, Clinical (Licence: WI 7590) | |
| Enumeration Date | 2007-01-17 |
| Last Update Date | 2014-04-22 |