| NPI | 1811223407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149.028252) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IN 87000461A) |
| 104100000X Social Worker (Licence: IN 33007055A) | |
| Enumeration Date | 2009-11-02 |
| Last Update Date | 2025-08-14 |