| NPI | 1407229248 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 1041C0700X.) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 101YP2500X Counselor, Professional | |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2015-11-02 |
| Last Update Date | 2024-01-09 |