NPI | 1053640284 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MD 13822) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MD AC1591) |
Enumeration Date | 2009-12-17 |
Last Update Date | 2015-07-15 |