| NPI | 1245602937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 78781) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CA 78781) |
| 101YM0800X Counselor, Mental Health (Licence: CA 78781) | |
| 104100000X Social Worker (Licence: CA 78781) | |
| Enumeration Date | 2015-10-21 |
| Last Update Date | 2022-07-21 |