| NPI | 1730424169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C009966) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC LCAS-3040) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: SC LAC768) | |
| 1041C0700X Social Worker, Clinical (Licence: SC 12473) | |
| Enumeration Date | 2012-12-12 |
| Last Update Date | 2023-01-04 |