| NPI | 1376289553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MO 14360) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MO 2023019967) |
| Enumeration Date | 2022-05-10 |
| Last Update Date | 2023-06-21 |