| NPI | 1194246215 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 114111) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CA 84997) |
| Enumeration Date | 2017-06-28 |
| Last Update Date | 2023-05-31 |