| NPI | 1104475128 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 103797) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 83088) |
| 101YM0800X Counselor, Mental Health (Licence: CA 103797) | |
| Enumeration Date | 2019-09-11 |
| Last Update Date | 2023-04-11 |