| NPI | 1558494245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: WV TL076111350) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WV TL076111350) |
| 101YM0800X Counselor, Mental Health (Licence: WV TL076111350) | |
| 104100000X Social Worker (Licence: WV TL076111350) | |
| Enumeration Date | 2007-03-13 |
| Last Update Date | 2007-07-08 |