| NPI | 1750307815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: WI 3049) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 1928) |
| 101Y00000X Counselor (Licence: WI 3049) | |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2021-11-02 |