| NPI | 1922545326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CA 107943) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: CA LR05621120) | |
| Enumeration Date | 2017-01-23 |
| Last Update Date | 2024-03-20 |