| NPI | 1164035762 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CA 82308) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: CA 82308) |
| Enumeration Date | 2020-08-25 |
| Last Update Date | 2023-11-06 |