| NPI | 1801160452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: IN 99071665A) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: IN 87001398A) |
| Enumeration Date | 2012-02-29 |
| Last Update Date | 2016-10-14 |