| NPI | 1720470065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: WI 129620) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 17284) |
| Enumeration Date | 2015-02-24 |
| Last Update Date | 2015-02-24 |