| NPI | 1457063661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OR 24-QMHA-R-5932) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR T-22-2133) | |
| Enumeration Date | 2022-12-19 |
| Last Update Date | 2024-09-28 |