| NPI | 1598935157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Additional Taxonomies | 1041S0200X Social Worker School (Licence: MA 1029720) |
| 101YA0400X Counselor Addiction (Substance Use Disorder) | |
| Enumeration Date | 2008-03-10 |
| Last Update Date | 2009-02-17 |