| NPI | 1245908151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 101YA0400X Counselor Addiction (Substance Use Disorder) | |
| 101YS0200X Counselor School | |
| 103K00000X Behavior Analyst | |
| 1041C0700X Social Worker Clinical | |
| Enumeration Date | 2021-09-03 |
| Last Update Date | 2022-03-01 |