| NPI | 1194988428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW110205) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA ASW94985) |
| 104100000X Social Worker (Licence: CA ASW94985) | |
| Enumeration Date | 2008-07-07 |
| Last Update Date | 2022-09-23 |