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 |