| NPI | 1568544310 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: WI 2004) |
| Additional Taxonomies | 104100000X Social Worker (Licence: WI 3229-123) |
| 104100000X Social Worker (Licence: WI 11912) | |
| Enumeration Date | 2006-10-20 |
| Last Update Date | 2007-07-08 |