| NPI | 1649547522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| Additional Taxonomies | 101Y00000X Counselor |
| 104100000X Social Worker | |
| 1041C0700X Social Worker Clinical | |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2011-11-21 |
| Last Update Date | 2011-11-21 |