| NPI | 1689719965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA Cert# H0412241242) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 104100000X Social Worker (Licence: TX LBSW# 21021) | |
| Enumeration Date | 2007-02-21 |
| Last Update Date | 2007-07-08 |