| NPI | 1245372325 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 29581) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 18502) |
| 101YM0800X Counselor, Mental Health (Licence: CA 25185) | |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2019-04-09 |