| NPI | 1376180141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA LR03190426) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CA ASW131176) |
| Enumeration Date | 2019-11-29 |
| Last Update Date | 2026-04-15 |