| NPI | 1639896160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: S.2404004-TRNE) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA183079) |
| 101YM0800X Counselor, Mental Health (Licence: QMHS) | |
| Enumeration Date | 2022-10-25 |
| Last Update Date | 2024-12-10 |