| NPI | 1124885900 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 142029) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 121163) |
| Enumeration Date | 2024-02-28 |
| Last Update Date | 2026-09-01 |