| NPI | 1629595673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 132464) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA 778-R) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA C061540620) | |
| Enumeration Date | 2017-08-29 |
| Last Update Date | 2025-11-19 |