| NPI | 1790465151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: MT 63794) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: MT 56615) |
| Enumeration Date | 2023-07-20 |
| Last Update Date | 2024-01-25 |