| NPI | 1821715343 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: HI LSW-2946) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: HI 1936-17) |
| Enumeration Date | 2022-10-25 |
| Last Update Date | 2024-09-14 |