| NPI | 1184170490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW101666) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 73009) |
| Enumeration Date | 2016-08-27 |
| Last Update Date | 2021-06-08 |