| NPI | 1134672496 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NE 2281) |
| Additional Taxonomies | 104100000X Social Worker |
| Enumeration Date | 2016-08-03 |
| Last Update Date | 2025-02-18 |