| NPI | 1588036545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WI 8300-123) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WI 8300-123) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 15603-132) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 15442-134) | |
| Enumeration Date | 2015-10-29 |
| Last Update Date | 2024-01-23 |