| NPI | 1184902504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OR 5855) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NV 00686) |
| 1041C0700X Social Worker, Clinical (Licence: NV 5214-S) | |
| Enumeration Date | 2011-08-02 |
| Last Update Date | 2014-06-06 |