| NPI | 1164684817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA LW60509544) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: AZ LISAC-10713) |
| 1041C0700X Social Worker, Clinical | |
| 1041C0700X Social Worker, Clinical (Licence: AZ LCSW-12502) | |
| Enumeration Date | 2008-06-25 |
| Last Update Date | 2022-09-30 |