| NPI | 1043525306 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CA LCSW82321) |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YM0800X Counselor Mental Health (Licence: CA ASW63240) | |
| Enumeration Date | 2010-08-11 |
| Last Update Date | 2019-08-19 |