| NPI | 1356344899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MD 05478) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MD LCA030) |
| 101YM0800X Counselor, Mental Health (Licence: MD LCO531) | |
| 101YP2500X Counselor, Professional (Licence: MD LCO531) | |
| 171WH0202X Contractor, Home Modifications | |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| 347C00000X Private Vehicle | |
| Enumeration Date | 2005-05-28 |
| Last Update Date | 2025-01-08 |