| NPI | 1720503907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 105318) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 1041C0700X Social Worker, Clinical (Licence: MA 122881) | |
| Enumeration Date | 2017-08-08 |
| Last Update Date | 2025-12-17 |