| NPI | 1245384833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW27639) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA ASW20317) |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2011-09-26 |