| NPI | 1467066282 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 1541) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CA 111541) |
| 1041S0200X Social Worker, School (Licence: CA 111541) | |
| Enumeration Date | 2020-08-31 |
| Last Update Date | 2023-10-11 |