| NPI | 1386034155 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WI 8531-123) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 15822-132) |
| 104100000X Social Worker (Licence: WI 129335-121) | |
| Enumeration Date | 2015-01-30 |
| Last Update Date | 2024-03-12 |