| NPI | 1164080446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW118543) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CA ASW97204) |
| 171M00000X Case Manager/Care Coordinator | |
| 101YM0800X Counselor, Mental Health (Licence: CA ASW97204) | |
| Enumeration Date | 2019-06-03 |
| Last Update Date | 2023-10-24 |