| NPI | 1962514497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NH 1282) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NH 322) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2015-01-09 |