| NPI | 1073137394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: GA CSW008097) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: GA MSW008943) |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2020-06-02 |
| Last Update Date | 2024-02-16 |