| NPI | 1295344133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 122955) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 122955) |
| 104100000X Social Worker (Licence: CA 98257) | |
| Enumeration Date | 2020-07-27 |
| Last Update Date | 2025-03-07 |