| NPI | 1124365838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW112501) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CA 90806) |
| Enumeration Date | 2013-01-15 |
| Last Update Date | 2023-06-14 |