| NPI | 1306326970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 110394) |
| Enumeration Date | 2018-08-14 |
| Last Update Date | 2025-10-03 |