| NPI | 1780942334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: CA ASW70101) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CA 70101) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA 03-109797) | |
| Enumeration Date | 2012-05-01 |
| Last Update Date | 2020-02-14 |