| NPI | 1104574391 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: CA 117669) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA R1515920723) |
| Enumeration Date | 2022-03-16 |
| Last Update Date | 2026-07-06 |