| NPI | 1396864989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: CA LCSW87108) |
| Additional Taxonomies | 101Y00000X Counselor |
| 225C00000X Rehabilitation Counselor | |
| Enumeration Date | 2007-03-28 |
| Last Update Date | 2022-04-01 |