| NPI | 1144776741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC 22804-A) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NC C016600) |
| Enumeration Date | 2016-09-01 |
| Last Update Date | 2023-12-18 |