| NPI | 1912336835 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 122683) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA ASW102529) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA Aii057290518) | |
| Enumeration Date | 2013-11-01 |
| Last Update Date | 2024-07-05 |