| NPI | 1114242724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: UT 9781200-3501) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: NC C007378) |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NC 1681) | |
| Enumeration Date | 2010-04-07 |
| Last Update Date | 2021-12-20 |