| NPI | 1154921799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WV BP00945821) |
| Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) |
| 1041C0700X Social Worker, Clinical (Licence: WV SW062015550) | |
| Enumeration Date | 2020-10-30 |
| Last Update Date | 2021-02-01 |