| NPI | 1134359839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 73682) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 28846) |
| Enumeration Date | 2009-07-16 |
| Last Update Date | 2023-06-15 |