| NPI | 1235336215 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 93663) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA ACSW73503) |
| Enumeration Date | 2007-07-02 |
| Last Update Date | 2022-03-25 |