| NPI | 1851858708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW121734) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA 199584) | |
| 101YM0800X Counselor, Mental Health (Licence: CA 96334) | |
| Enumeration Date | 2019-02-27 |
| Last Update Date | 2024-12-11 |