| NPI | 1457696759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 71151) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA RALR10160914) |
| Enumeration Date | 2012-11-28 |
| Last Update Date | 2016-12-08 |