| NPI | 1215801709 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: SD 6942) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: SD 8532) |
| Enumeration Date | 2025-09-30 |
| Last Update Date | 2025-10-21 |