| NPI | 1679053342 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CA 112333) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: CA R12361610816) |
| Enumeration Date | 2018-08-21 |
| Last Update Date | 2023-03-02 |