| NPI | 1861994386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA ASW139166) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA 10050) |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2018-02-28 |
| Last Update Date | 2026-07-06 |