| NPI | 1467516583 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: CA 23401) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CA 23401) |
| 1041C0700X Social Worker, Clinical (Licence: CA 23401) | |
| 1041C0700X Social Worker, Clinical (Licence: CA LCS23401) | |
| Enumeration Date | 2006-12-21 |
| Last Update Date | 2021-11-15 |