| NPI | 1093826299 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: DC LC50078081) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: DC 10191-502) |
| 1041C0700X Social Worker, Clinical (Licence: MD 13207) | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2009-10-24 |