| NPI | 1770703431 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WI 8420-123) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 15382-132) |
| 101YM0800X Counselor, Mental Health (Licence: WI 8420-123) | |
| Enumeration Date | 2007-04-26 |
| Last Update Date | 2024-04-01 |