| NPI | 1134534407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 89604) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 72097) |
| Enumeration Date | 2014-06-25 |
| Last Update Date | 2021-06-02 |