| NPI | 1609221308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: ID LCSW-44631) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: ID CADC-11672) |
| 1041C0700X Social Worker, Clinical (Licence: ID LCSW-44631) | |
| Enumeration Date | 2016-05-01 |
| Last Update Date | 2025-05-20 |