| NPI | 1245613819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW99030) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MD LCA400) |
| 1041C0700X Social Worker, Clinical (Licence: MD 12360) | |
| Enumeration Date | 2015-07-01 |
| Last Update Date | 2021-05-05 |