| NPI | 1316629314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 118816) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 118816) |
| 104100000X Social Worker | |
| 1041C0700X Social Worker, Clinical | |
| Enumeration Date | 2023-08-01 |
| Last Update Date | 2024-03-04 |