| NPI | 1235294471 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: CA 97075) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 97075) |
| 1041C0700X Social Worker, Clinical (Licence: CA 63933) | |
| Enumeration Date | 2006-12-27 |
| Last Update Date | 2022-01-07 |