| NPI | 1851444749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 272) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WI 1128125) |
| 104100000X Social Worker (Licence: WI 2402120) | |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2007-07-08 |