| NPI | 1891082418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: SC 10722) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC 1916) |
| 1041C0700X Social Worker, Clinical (Licence: NC C008711) | |
| Enumeration Date | 2011-07-03 |
| Last Update Date | 2017-02-05 |