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 |