| NPI | 1962607069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IA 06R112) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NE 619) |
| 101YM0800X Counselor, Mental Health (Licence: NE 7794) | |
| 104100000X Social Worker (Licence: NE 6457) | |
| Enumeration Date | 2007-06-19 |
| Last Update Date | 2025-09-11 |