| NPI | 1396328761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CA ASW109287) |
| 104100000X Social Worker (Licence: CA 109287) | |
| Enumeration Date | 2021-05-03 |
| Last Update Date | 2023-05-09 |