| NPI | 1346800208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA ACSW103453) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA ASW103453) |
| 101YM0800X Counselor, Mental Health (Licence: CA ASW67374) | |
| 225400000X Rehabilitation Practitioner | |
| Enumeration Date | 2019-06-13 |
| Last Update Date | 2023-06-05 |