| NPI | 1942458666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: TN LSW0000000734) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: TN LDC0000000185) |
| Enumeration Date | 2008-09-06 |
| Last Update Date | 2008-11-14 |