| NPI | 1326563065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW83047) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CA 34229) |
| 1041C0700X Social Worker, Clinical (Licence: CA ASW34229) | |
| Enumeration Date | 2017-08-03 |
| Last Update Date | 2018-06-29 |