| NPI | 1790776565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: WI 14354-132) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical |
| Enumeration Date | 2005-11-02 |
| Last Update Date | 2010-05-18 |