| NPI | 1457099111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 136568) |
| Additional Taxonomies | 104100000X Social Worker |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2022-05-23 |
| Last Update Date | 2026-02-04 |