| NPI | 1861565574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: AR 1870C) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: AR 1870-C) |
| 101YP2500X Counselor, Professional (Licence: AR 1870-C) | |
| Enumeration Date | 2006-11-17 |
| Last Update Date | 2017-11-28 |