| NPI | 1962150326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: DE 2042) |
| Additional Taxonomies | 104100000X Social Worker (Licence: DE Q3-0011592) |
| Enumeration Date | 2022-03-15 |
| Last Update Date | 2025-12-03 |