| NPI | 1437544368 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 109627) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 101YM0800X Counselor, Mental Health (Licence: CA 109627) | |
| Enumeration Date | 2015-03-30 |
| Last Update Date | 2023-06-28 |