| NPI | 1538404595 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NC C009396) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NC 3079-A) |
| 1041C0700X Social Worker Clinical (Licence: NC P007638) | |
| Enumeration Date | 2012-12-03 |
| Last Update Date | 2018-02-05 |