| NPI | 1144751579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA ASW112732) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA ASW112732) |
| 101YM0800X Counselor, Mental Health (Licence: CA ASW76018) | |
| Enumeration Date | 2017-03-27 |
| Last Update Date | 2023-06-09 |