| NPI | 1871137034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MT BBH-LAC-LIC-33154) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MT BBH-SWLC-LIC-48355) |
| Enumeration Date | 2019-10-31 |
| Last Update Date | 2023-09-08 |