| NPI | 1184968448 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: SC 9195) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: SC 1404045) |
| Enumeration Date | 2012-11-26 |
| Last Update Date | 2016-02-04 |