| NPI | 1245999309 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 137072) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CA 200177) |
| 101YM0800X Counselor, Mental Health (Licence: CA 98984) | |
| 104100000X Social Worker (Licence: CA 98984) | |
| Enumeration Date | 2021-12-15 |
| Last Update Date | 2026-02-23 |