| NPI | 1518976703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WI 632123) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 12275) |
| 1041S0200X Social Worker, School | |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2008-02-13 |