NPI | 1740633056 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: SC 15130) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC 23132) |
1041C0700X Social Worker, Clinical (Licence: NC C011696) | |
Enumeration Date | 2016-07-21 |
Last Update Date | 2023-02-20 |