| NPI | 1780132894 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: CA 124462) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-09-17 |
| Last Update Date | 2024-08-02 |