| NPI | 1962895318 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: DE Q3-0000164) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: DE CD-0000100) |
| 103K00000X Behavior Analyst (Licence: PA BH004301) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: DE 1460) | |
| Enumeration Date | 2015-03-10 |
| Last Update Date | 2023-08-02 |