| NPI | 1245726876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: AZ 16152) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: AZ 11481) |
| 1041C0700X Social Worker, Clinical (Licence: CA 28616) | |
| Enumeration Date | 2018-07-06 |
| Last Update Date | 2018-07-06 |