| NPI | 1114576188 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 138886) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 97746) |
| 101YM0800X Counselor, Mental Health | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| Enumeration Date | 2019-09-11 |
| Last Update Date | 2026-06-01 |