| NPI | 1306484118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NE 1142) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NE 11536) |
| 104100000X Social Worker (Licence: NE 7307) | |
| Enumeration Date | 2019-12-12 |
| Last Update Date | 2019-12-12 |