| NPI | 1730209180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: DC DC3000819) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 102L00000X Psychoanalyst | |
| Enumeration Date | 2007-03-30 |
| Last Update Date | 2022-05-10 |