| NPI | 1003237785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C009802) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC 3528-A) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC 3528) | |
| 1041C0700X Social Worker, Clinical (Licence: NC P008345) | |
| Enumeration Date | 2013-12-23 |
| Last Update Date | 2018-07-31 |