| NPI | 1801117049 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: TN 5873) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OK 308) |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: TN C83434) | |
| 101YM0800X Counselor Mental Health (Licence: TN 5873) | |
| Enumeration Date | 2010-06-22 |
| Last Update Date | 2010-06-22 |