| NPI | 1194003020 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 68815) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: 29333) |
| Enumeration Date | 2011-07-26 |
| Last Update Date | 2022-06-08 |