| NPI | 1992034078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WI 8914-123) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 15651-132) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 15552-131) | |
| Enumeration Date | 2009-12-18 |
| Last Update Date | 2022-10-24 |