| NPI | 1043693781 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW105916) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 74645) |
| 104100000X Social Worker (Licence: CA 74645) | |
| Enumeration Date | 2015-06-30 |
| Last Update Date | 2021-12-20 |