| NPI | 1659945699 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 142550) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 113111) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| Enumeration Date | 2021-05-14 |
| Last Update Date | 2026-09-25 |