| NPI | 1992131056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: ID LSW-24218) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: ID 10002) |
| Enumeration Date | 2013-09-20 |
| Last Update Date | 2013-09-23 |