| NPI | 1225695166 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041S0200X Social Worker, School (Licence: MD G08273) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MD LCA246) |
| Enumeration Date | 2019-05-28 |
| Last Update Date | 2019-05-28 |