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 |