| NPI | 1649627795 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC 21985) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NC PO10755) |
| 1041C0700X Social Worker, Clinical (Licence: NC P015590) | |
| Enumeration Date | 2016-05-18 |
| Last Update Date | 2023-04-18 |