| NPI | 1386922797 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: CA ASW90211) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA 01331214) |
| 101YM0800X Counselor, Mental Health (Licence: CA 90211) | |
| Enumeration Date | 2011-08-02 |
| Last Update Date | 2023-06-08 |