| NPI | 1295281566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NM X-09715) |
| Additional Taxonomies | 324500000X Substance Abuse Rehabilitation Facility (Licence: NM X-09715) |
| Enumeration Date | 2016-08-28 |
| Last Update Date | 2023-09-18 |