| NPI | 1912462011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 96606) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA 9113) | |
| Enumeration Date | 2019-02-04 |
| Last Update Date | 2021-02-19 |