| NPI | 1922136274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MO 2007004028) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MO 2007004028) |
| 104100000X Social Worker (Licence: MO 2007004028) | |
| 1041C0700X Social Worker, Clinical (Licence: MO 2007004028) | |
| Enumeration Date | 2007-03-01 |
| Last Update Date | 2009-10-06 |