| NPI | 1821112947 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 85783) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA 36663) |
| 104100000X Social Worker (Licence: CA 36663) | |
| 225400000X Rehabilitation Practitioner | |
| Enumeration Date | 2007-03-16 |
| Last Update Date | 2023-11-20 |