NPI | 1790888121 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: PR 8320) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: PR 05-20-6983) |
Enumeration Date | 2006-09-07 |
Last Update Date | 2013-04-05 |