| NPI | 1497269682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 113634) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 80728) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| Enumeration Date | 2017-11-27 |
| Last Update Date | 2023-06-09 |