| NPI | 1962290817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: GA MSW011870) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: GA MSW011870) |
| 101YM0800X Counselor, Mental Health (Licence: GA MSW011870) | |
| 101YP2500X Counselor, Professional (Licence: GA MSW011870) | |
| 171M00000X Case Manager/Care Coordinator (Licence: GA MSW011870) | |
| 171W00000X Contractor | |
| 175T00000X Peer Specialist | |
| Enumeration Date | 2025-04-29 |
| Last Update Date | 2025-05-06 |