| NPI | 1760599229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: WI 2461-123) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 1320-132) |
| 101YP2500X Counselor, Professional (Licence: WI 2599-125) | |
| 1041C0700X Social Worker, Clinical (Licence: WI 2461-123) | |
| Enumeration Date | 2006-08-23 |
| Last Update Date | 2018-01-16 |