| NPI | 1972626661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MA 1179) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA 202740) |
| Enumeration Date | 2007-04-09 |
| Last Update Date | 2007-07-08 |