| NPI | 1457845943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CT 005243) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: CT 000660) |
| Enumeration Date | 2018-06-18 |
| Last Update Date | 2019-03-22 |