| NPI | 1578840344 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: PR 64089) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: PR 10633) |
| 104100000X Social Worker (Licence: PR 10633) | |
| Enumeration Date | 2011-11-08 |
| Last Update Date | 2023-07-05 |