| NPI | 1760030878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: CA ASW-131521) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA Bii00790824) |
| Enumeration Date | 2019-09-01 |
| Last Update Date | 2025-07-03 |