| NPI | 1063966596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 101754) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 78451) |
| Enumeration Date | 2016-08-13 |
| Last Update Date | 2022-07-21 |