NPI | 1043762321 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 122092) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2016-11-02 |
Last Update Date | 2024-04-22 |