| NPI | 1164269361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: AR 501L) |
| Additional Taxonomies | 104100000X Social Worker (Licence: AR 22989-M) |
| Enumeration Date | 2024-07-15 |
| Last Update Date | 2025-01-12 |