| NPI | 1700143245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 1041C0700X Social Worker, Clinical (Licence: NC C008904) | |
| 1041C0700X Social Worker, Clinical (Licence: VA 0904010225) | |
| 1041C0700X Social Worker, Clinical (Licence: GA CSW009305) | |
| Enumeration Date | 2012-04-23 |
| Last Update Date | 2025-03-19 |