| NPI | 1790201432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CA 130717) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: CA R1466610422) |
| 171M00000X Case Manager/Care Coordinator (Licence: CA R1466610422) | |
| 175T00000X Peer Specialist | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-08-15 |
| Last Update Date | 2025-08-07 |