| NPI | 1770235764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MT BBH-LAC-LIC-55813) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MT BBH-SLWC-LIC-77078) |
| Enumeration Date | 2022-01-21 |
| Last Update Date | 2025-12-02 |