| NPI | 1649449992 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: MI 6802065259) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: MI 1-00091) |
| Enumeration Date | 2008-02-20 |
| Last Update Date | 2008-02-20 |