| NPI | 1518167881 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WI 1300-123) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 451-132) |
| 101YP2500X Counselor, Professional (Licence: WI 540-125) | |
| Enumeration Date | 2007-07-24 |
| Last Update Date | 2007-07-24 |