| NPI | 1427315258 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: PA CW022955) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MT BBH-LAC-LIC-42678) |
| 1041C0700X Social Worker, Clinical (Licence: MT 1009) | |
| Enumeration Date | 2012-04-18 |
| Last Update Date | 2023-04-19 |