| NPI | 1417608035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 133445) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR T-21-1344) |
| 225400000X Rehabilitation Practitioner | |
| Enumeration Date | 2022-01-14 |
| Last Update Date | 2025-08-29 |