| NPI | 1851921134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: CA 132717) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA 11187) |
| 1041C0700X Social Worker, Clinical (Licence: CA 132717) | |
| Enumeration Date | 2020-01-25 |
| Last Update Date | 2025-09-18 |