| NPI | 1104479823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: CA 111358) |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YM0800X Counselor Mental Health | |
| 101YA0400X Counselor Addiction (Substance Use Disorder) | |
| Enumeration Date | 2019-07-22 |
| Last Update Date | 2024-02-29 |