| NPI | 1679638720 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: LA ccgc 113) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: LA lcsw 3782) |
| Enumeration Date | 2006-12-27 |
| Last Update Date | 2025-09-11 |