| NPI | 1538802137 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| 106S00000X Behavior Technician | |
| Enumeration Date | 2022-04-20 |
| Last Update Date | 2025-08-29 |