| NPI | 1093338766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C015364) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NC LCAS-26462) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC LCAS-26462) | |
| Enumeration Date | 2020-05-28 |
| Last Update Date | 2022-10-03 |