| NPI | 1982267688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC P015364) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC 26118) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC CSAC-24507) | |
| Enumeration Date | 2019-04-17 |
| Last Update Date | 2020-10-25 |