| NPI | 1811416209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: CA ASW105240) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: CA R1249280417) |
| 1041C0700X Social Worker Clinical (Licence: CA ASW105240) | |
| Enumeration Date | 2017-09-17 |
| Last Update Date | 2022-07-27 |