| 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 |