| NPI | 1366826083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MD AC0574) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MD 29509) |
| Enumeration Date | 2015-07-13 |
| Last Update Date | 2025-12-08 |