| NPI | 1497539811 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 132836) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA Ci27730719) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2023-08-24 |
| Last Update Date | 2026-02-05 |