| NPI | 1477045862 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C013190) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC LCAS-24678) |
| 1041C0700X Social Worker, Clinical (Licence: NC P012511) | |
| Enumeration Date | 2018-06-01 |
| Last Update Date | 2020-11-18 |