| NPI | 1043558018 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: HI LCSW-4659-0) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: HI 1874-15) |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2013-01-24 |
| Last Update Date | 2021-05-28 |