| NPI | 1972875060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: AL 2469C) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| 1041C0700X Social Worker Clinical (Licence: TX 55579) | |
| Enumeration Date | 2012-02-03 |
| Last Update Date | 2012-05-25 |