| NPI | 1306339221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 135626) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 104100000X Social Worker (Licence: CA 109463) | |
| 101Y00000X Counselor | |
| Enumeration Date | 2018-06-14 |
| Last Update Date | 2026-05-11 |