| NPI | 1528565488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ID LCSW-42204) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: ID 10046) |
| 104100000X Social Worker (Licence: ID 37236) | |
| Enumeration Date | 2018-04-08 |
| Last Update Date | 2022-06-21 |