| NPI | 1356220438 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: LA LAC-5189) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: LA 311) |
| 104100000X Social Worker (Licence: LA 19275) | |
| Enumeration Date | 2025-09-02 |
| Last Update Date | 2025-11-15 |