| NPI | 1811264757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: AK 1078) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: AK 2262) |
| Enumeration Date | 2011-11-21 |
| Last Update Date | 2016-09-13 |