| NPI | 1548871338 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC LCAS-26092) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NC P015251) |
| Enumeration Date | 2020-08-14 |
| Last Update Date | 2024-09-17 |