| NPI | 1457815680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MD LCA3060) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MD 27413) |
| Enumeration Date | 2019-01-22 |
| Last Update Date | 2025-08-11 |