| NPI | 1881202513 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: PR 14720) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: PR TAC-III-05-20-3296) |
| Enumeration Date | 2020-07-20 |
| Last Update Date | 2020-10-28 |