| NPI | 1710300900 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C009750) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC 20095) |
| 1041C0700X Social Worker, Clinical (Licence: NC P008373) | |
| Enumeration Date | 2014-01-24 |
| Last Update Date | 2024-05-08 |