| NPI | 1689944910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 1041S0200X Social Worker, School | |
| 251S00000X Community/Behavioral Health | |
| Enumeration Date | 2012-01-03 |
| Last Update Date | 2018-02-15 |