| NPI | 1811923691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C005334) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC 1016) |
| 174400000X Specialist (Licence: NC 25502) | |
| Enumeration Date | 2006-06-24 |
| Last Update Date | 2008-12-17 |