| NPI | 1417352501 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 99620) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 73873) |
| 1041S0200X Social Worker, School | |
| Enumeration Date | 2014-10-31 |
| Last Update Date | 2025-01-13 |