NPI | 1013398064 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ID LCSW-32810) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: ID LCSW-32810) |
Enumeration Date | 2015-06-16 |
Last Update Date | 2015-06-16 |