| NPI | 1255717633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 126868) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 96222) |
| 104100000X Social Worker (Licence: CA ASW96222) | |
| 225400000X Rehabilitation Practitioner | |
| Enumeration Date | 2015-08-07 |
| Last Update Date | 2024-10-23 |