| NPI | 1417144767 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CA 85301) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: CA 33763) |
| Enumeration Date | 2007-10-01 |
| Last Update Date | 2021-04-01 |