| NPI | 1760029045 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 103156) |
| Enumeration Date | 2019-12-05 |
| Last Update Date | 2021-10-26 |