| NPI | 1285158659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: CA 106133) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 101YM0800X Counselor, Mental Health (Licence: CA MSW16133) | |
| Enumeration Date | 2017-07-27 |
| Last Update Date | 2026-01-05 |