| NPI | 1811392384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MT bbh-lcsw-lic-24114) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MT LAC-LAC-LIC-4174) |
| Enumeration Date | 2014-10-27 |
| Last Update Date | 2022-07-21 |