| NPI | 1447389853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC 1054) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: SC 1104) |
| Enumeration Date | 2007-03-02 |
| Last Update Date | 2016-03-28 |