| NPI | 1952417081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CT 006712) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: CT 000554) |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2012-02-08 |