| NPI | 1457483919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041S0200X Social Worker School (Licence: CA 29603) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 101YS0200X Counselor School | |
| 1041C0700X Social Worker Clinical (Licence: CA 29603) | |
| Enumeration Date | 2007-03-11 |
| Last Update Date | 2024-03-01 |