| NPI | 1205589652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 106405) |
| Enumeration Date | 2022-01-26 |
| Last Update Date | 2023-06-23 |