| NPI | 1316228000 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IN 34007166A) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: KY 5074) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IN 34007166A) | |
| Enumeration Date | 2011-09-08 |
| Last Update Date | 2022-10-17 |