| NPI | 1043613144 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MT 16657) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MT 4172) |
| Enumeration Date | 2014-10-02 |
| Last Update Date | 2016-10-14 |