| NPI | 1124454814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: ID LSW-2652) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR CADCI 04-07-19) |
| Enumeration Date | 2013-09-25 |
| Last Update Date | 2013-09-25 |