| NPI | 1467012195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: UT 9089601-6008) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: UT 9089601-3502) |
| Enumeration Date | 2019-06-14 |
| Last Update Date | 2022-01-26 |