| NPI | 1861889016 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C010942) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC 21422) |
| Enumeration Date | 2015-04-24 |
| Last Update Date | 2026-09-10 |