| NPI | 1710309059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WI 8678-123) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 17043-130) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 16116-132) | |
| Enumeration Date | 2014-01-06 |
| Last Update Date | 2021-06-02 |