| NPI | 1720300486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: MO 002193) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: MO 205276) |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: MO 501699) | |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: MO 138) | |
| 1041C0700X Social Worker Clinical (Licence: TX 52026) | |
| Enumeration Date | 2010-02-23 |
| Last Update Date | 2010-02-23 |