| NPI | 1972307478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CT 1617) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CT 11232) |
| Enumeration Date | 2025-04-03 |
| Last Update Date | 2025-12-06 |