| NPI | 1457842874 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 114628) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 84866) |
| Enumeration Date | 2018-05-21 |
| Last Update Date | 2023-12-29 |