| NPI | 1023311503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 99295) |
| Additional Taxonomies | 101Y00000X Counselor |
| 104100000X Social Worker | |
| 104100000X Social Worker (Licence: CA 70937) | |
| Enumeration Date | 2010-12-06 |
| Last Update Date | 2021-06-02 |