| NPI | 1558716670 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: WI 16960-130) |
| Additional Taxonomies | 104100000X Social Worker (Licence: WI 11508-120) |
| Enumeration Date | 2016-04-26 |
| Last Update Date | 2016-04-26 |