| NPI | 1003327636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 114266) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 104100000X Social Worker (Licence: CA 114266) | |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2017-10-23 |
| Last Update Date | 2024-02-06 |