| NPI | 1568915452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW87637) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CA ASW72258) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA RA8390716) | |
| Enumeration Date | 2016-07-27 |
| Last Update Date | 2019-03-26 |