| NPI | 1457924631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MT BBH-LAC-LIC-49001) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MT BBH-LCSW-LIC-70982) |
| Enumeration Date | 2021-07-23 |
| Last Update Date | 2024-07-15 |