| NPI | 1619423779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: CA ACSW105832) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| 104100000X Social Worker | |
| 104100000X Social Worker (Licence: CA 105832) | |
| Enumeration Date | 2016-08-29 |
| Last Update Date | 2022-06-08 |