| NPI | 1275002396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA 141603) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 141603) |
| 172V00000X Community Health Worker | |
| Enumeration Date | 2018-11-19 |
| Last Update Date | 2025-09-24 |