| NPI | 1629453014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CT 010301) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: CT 001719) |
| 101YM0800X Counselor Mental Health (Licence: CT 001719) | |
| 104100000X Social Worker (Licence: CT 001719) | |
| Enumeration Date | 2015-07-27 |
| Last Update Date | 2018-08-30 |