| NPI | 1124357785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 86317) |
| Additional Taxonomies | 101Y00000X Counselor |
| 104100000X Social Worker | |
| Enumeration Date | 2009-12-10 |
| Last Update Date | 2020-08-05 |