| NPI | 1770434599 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MT BBH-LAC-LIC-87816) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MT BBH-SWLC-LIC-88623) |
| Enumeration Date | 2026-02-06 |
| Last Update Date | 2026-05-14 |