| NPI | 1083916357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 75283) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CA 27856) |
| Enumeration Date | 2010-11-18 |
| Last Update Date | 2020-07-17 |