NPI | 1902584519 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO ACD.0002764) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health |
104100000X Social Worker | |
Enumeration Date | 2023-07-05 |
Last Update Date | 2025-07-08 |