| NPI | 1316451479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical |
| Enumeration Date | 2017-11-28 |
| Last Update Date | 2017-11-28 |