| NPI | 1740320654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: HI 3632) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: HI 1465-09) |
| Enumeration Date | 2007-02-08 |
| Last Update Date | 2011-12-06 |