| NPI | 1801954102 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WI 1602-123) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: WI 153-124) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 1817-132) | |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2015-03-05 |