| NPI | 1821191123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MA 0873AD) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MA 103356) |
| Enumeration Date | 2006-09-06 |
| Last Update Date | 2007-07-08 |