| NPI | 1609839620 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: PA CW013854) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: PA 4530) |
| 1041C0700X Social Worker Clinical (Licence: DE Q10000516) | |
| Enumeration Date | 2006-04-10 |
| Last Update Date | 2018-08-10 |