| NPI | 1023662467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 120323) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 95293) |
| 1041C0700X Social Worker, Clinical (Licence: CA 95293) | |
| Enumeration Date | 2019-07-24 |
| Last Update Date | 2024-01-18 |