| NPI | 1124547351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CA ASW79068) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: CA ASW79068) |
| 1041S0200X Social Worker School (Licence: CA 170159039) | |
| Enumeration Date | 2017-09-19 |
| Last Update Date | 2022-07-21 |