| NPI | 1538540315 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 127816) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: PA CW026010) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| Enumeration Date | 2015-06-17 |
| Last Update Date | 2026-03-18 |