| NPI | 1053718312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 84943) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA ASW63459) |
| Enumeration Date | 2014-12-01 |
| Last Update Date | 2018-08-13 |