| NPI | 1104440163 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 116319) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CA 96963) |
| 101YM0800X Counselor, Mental Health (Licence: CA 96963) | |
| Enumeration Date | 2020-06-04 |
| Last Update Date | 2023-07-12 |