| NPI | 1528359890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MD 13987) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MD AD1488) |
| 1041C0700X Social Worker, Clinical (Licence: DC LC50079126) | |
| Enumeration Date | 2011-04-21 |
| Last Update Date | 2011-06-08 |