| NPI | 1699150987 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: CT 3479) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CT 1139) |
| Enumeration Date | 2015-07-28 |
| Last Update Date | 2017-05-08 |