| NPI | 1437680071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 120524) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| 1041C0700X Social Worker, Clinical | |
| Enumeration Date | 2017-03-24 |
| Last Update Date | 2025-05-08 |