| NPI | 1821652512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 139093) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| Enumeration Date | 2019-04-28 |
| Last Update Date | 2026-06-04 |