| NPI | 1962748426 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MT BBH-LCPC-LIC-7613) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MT BBH-LAC-LIC-2613) |
| 104100000X Social Worker (Licence: MT 7613) | |
| Enumeration Date | 2013-01-02 |
| Last Update Date | 2022-02-21 |