| NPI | 1669768750 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: SC 9378) |
| 1041C0700X Social Worker, Clinical (Licence: SC 9378) | |
| Enumeration Date | 2011-06-27 |
| Last Update Date | 2018-04-09 |