| NPI | 1649311481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IL 10284) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MO NCGC371-19) |
| 1041C0700X Social Worker, Clinical (Licence: MO SW002614) | |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2007-07-08 |