| NPI | 1033832456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: CA LCSW127806) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CA 103282Credential) |
| Enumeration Date | 2022-09-21 |
| Last Update Date | 2025-05-09 |