| NPI | 1326294679 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCS 29037) |
| Additional Taxonomies | 104100000X Social Worker |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2008-08-18 |
| Last Update Date | 2018-09-19 |