| NPI | 1316320872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: CA ASW122792) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| 101YM0800X Counselor Mental Health (Licence: CA ACSW122792) | |
| 1041C0700X Social Worker Clinical (Licence: CA ACSW122792) | |
| Enumeration Date | 2015-07-02 |
| Last Update Date | 2025-07-31 |