| NPI | 1326541202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| 172V00000X Community Health Worker | |
| Enumeration Date | 2018-03-16 |
| Last Update Date | 2023-12-01 |