| NPI | 1285223768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 99898) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 99898) |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2021-01-11 |
| Last Update Date | 2023-07-03 |