| NPI | 1831204296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: WI 2285) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 11335) |
| 1041C0700X Social Worker, Clinical (Licence: WI 2284-123) | |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2019-03-13 |