| NPI | 1366817470 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 90206) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 90206) |
| Enumeration Date | 2015-12-01 |
| Last Update Date | 2021-02-10 |