| NPI | 1386925287 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 88092) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CA ASW35465) |
| 104100000X Social Worker (Licence: CA 35465) | |
| Enumeration Date | 2011-09-06 |
| Last Update Date | 2021-11-30 |