| NPI | 1578684171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MD AC1013) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MD G12440) |
| Enumeration Date | 2007-04-02 |
| Last Update Date | 2007-07-08 |