| NPI | 1588320295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MO 2021036486) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MO 11808) |
| 1041C0700X Social Worker, Clinical (Licence: KS 05584) | |
| Enumeration Date | 2021-11-17 |
| Last Update Date | 2024-03-27 |