| NPI | 1407194046 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VA 0904004628) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: VA 0710000942) | |
| 101YP2500X Counselor, Professional (Licence: VA 0701002362) | |
| 106H00000X Marriage & Family Therapist (Licence: VA 0717000443) | |
| Enumeration Date | 2013-01-16 |
| Last Update Date | 2021-11-04 |