| NPI | 1689484362 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA ASW140455) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA 20581) | |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2025-01-13 |
| Last Update Date | 2026-08-24 |