| NPI | 1265825608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NH 1021) |
| Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: NH 0512) |
| Enumeration Date | 2015-03-10 |
| Last Update Date | 2015-03-10 |