| NPI | 1154797785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW88336) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CA ASW72526) |
| Enumeration Date | 2015-08-18 |
| Last Update Date | 2019-04-05 |