| NPI | 1376081471 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 88740) |
| Additional Taxonomies | 101Y00000X Counselor |
| 1041C0700X Social Worker, Clinical (Licence: CA 76619) | |
| Enumeration Date | 2017-02-08 |
| Last Update Date | 2021-06-01 |