| NPI | 1225405111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: CA 72052) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2015-08-26 |
| Last Update Date | 2016-11-10 |