| NPI | 1396968509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CA LCSW29366) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| Enumeration Date | 2007-04-10 |
| Last Update Date | 2016-08-03 |