| NPI | 1336599695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: CA 116245) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA 198972IV) |
| Enumeration Date | 2016-06-17 |
| Last Update Date | 2023-10-06 |