| NPI | 1972764660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 70624) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA 020573) |
| 101YM0800X Counselor, Mental Health (Licence: CA 70624) | |
| Enumeration Date | 2008-06-24 |
| Last Update Date | 2019-06-19 |