| NPI | 1154023190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CA ASW112457) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: CA ASW112457) |
| Enumeration Date | 2023-03-21 |
| Last Update Date | 2023-11-10 |