| NPI | 1922734508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 172V00000X Community Health Worker |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| 225400000X Rehabilitation Practitioner | |
| Enumeration Date | 2022-07-27 |
| Last Update Date | 2026-09-29 |