| NPI | 1518183151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MA 6532) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MA 393) | |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2008-05-19 |