| NPI | 1194058297 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CA LCSW76106) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: CA 31286) |
| 101YM0800X Counselor Mental Health (Licence: CA LCSW76106) | |
| Enumeration Date | 2009-09-08 |
| Last Update Date | 2021-04-22 |