| NPI | 1487838405 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 75509) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC 28294) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA 051108) | |
| 1041C0700X Social Worker, Clinical (Licence: NC C014289) | |
| Enumeration Date | 2007-12-27 |
| Last Update Date | 2023-10-18 |