| NPI | 1134242878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 138068) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA ASW131376) |
| 101YM0800X Counselor, Mental Health (Licence: CA ASW131376) | |
| Enumeration Date | 2007-04-09 |
| Last Update Date | 2026-04-20 |