| NPI | 1063622421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: LA LCSW-2289B) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: LA LAC-778) |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2014-11-20 |