| NPI | 1083847123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CA 64650) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 1041C0700X Social Worker Clinical (Licence: CT 012629) | |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2009-08-24 |
| Last Update Date | 2023-11-06 |