| NPI | 1295016855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NC C007425) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NC 1895) |
| 104100000X Social Worker (Licence: NC C007425) | |
| Enumeration Date | 2011-09-08 |
| Last Update Date | 2024-01-30 |