| NPI | 1629378013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: UT 7099669-3503) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: UT 7099669-6005) |
| Enumeration Date | 2010-11-01 |
| Last Update Date | 2013-01-04 |