| NPI | 1326409913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ID LCSW-38371) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: ID LMSW-34382) |
| Enumeration Date | 2016-03-10 |
| Last Update Date | 2023-08-09 |