| NPI | 1962739474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC 1548) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NC C007564) |
| Enumeration Date | 2009-11-05 |
| Last Update Date | 2011-12-12 |