| NPI | 1740634351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: GA T0086) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: GA EN799987) |
| 1041C0700X Social Worker, Clinical (Licence: GA 153504907886) | |
| Enumeration Date | 2016-04-20 |
| Last Update Date | 2016-04-20 |