| NPI | 1205291515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 94149) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 49379) |
| 101YM0800X Counselor, Mental Health (Licence: CA 94149) | |
| Enumeration Date | 2015-12-31 |
| Last Update Date | 2024-07-11 |