| NPI | 1720394562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IN 34005914a) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IN 87000061A) |
| Enumeration Date | 2010-08-30 |
| Last Update Date | 2019-02-14 |