| NPI | 1548616626 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC 23048) |
| Additional Taxonomies | 104100000X Social Worker |
| 1041C0700X Social Worker, Clinical (Licence: NC P010673) | |
| Enumeration Date | 2016-05-09 |
| Last Update Date | 2018-08-08 |