| NPI | 1518142983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: CA 88608) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA 580078-92) |
| Enumeration Date | 2008-01-04 |
| Last Update Date | 2021-03-16 |