| NPI | 1992157341 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CA 97367) |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: CA 12293411) | |
| Enumeration Date | 2016-07-11 |
| Last Update Date | 2023-04-12 |