| NPI | 1083099360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NC C010916) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NC 21675) |
| 1041C0700X Social Worker Clinical (Licence: NC P009574) | |
| Enumeration Date | 2015-07-28 |
| Last Update Date | 2018-01-16 |