| NPI | 1952518839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WI 3928) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 858) |
| 106H00000X Marriage & Family Therapist (Licence: WI 500) | |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2010-03-04 |