| NPI | 1083157085 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TN 1413) |
| Additional Taxonomies | 104100000X Social Worker (Licence: TN 12713) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: GA C0312) | |
| 104100000X Social Worker | |
| Enumeration Date | 2016-11-22 |
| Last Update Date | 2022-05-25 |