| NPI | 1710128764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MT 841-LCSW) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MT 1130) |
| Enumeration Date | 2009-03-19 |
| Last Update Date | 2022-01-01 |