| NPI | 1740687185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 102112) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA CADCA I42040814) |
| Enumeration Date | 2014-12-01 |
| Last Update Date | 2021-06-25 |