| NPI | 1174912232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 101Y00000X Counselor |
| 104100000X Social Worker (Licence: CA 97119) | |
| Enumeration Date | 2015-01-13 |
| Last Update Date | 2023-08-10 |