| NPI | 1962892372 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ID LCSW-39131) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: ID 10196) |
| 104100000X Social Worker (Licence: ID 33185) | |
| 104100000X Social Worker (Licence: ID LMSW-35837) | |
| Enumeration Date | 2015-01-23 |
| Last Update Date | 2020-01-28 |