| NPI | 1902584519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CSW.09932940) |
| Additional Taxonomies | 104100000X Social Worker |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO ACD.0002764) | |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2023-07-05 |
| Last Update Date | 2026-03-11 |