| NPI | 1467841619 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 89134) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 36507) |
| 101YM0800X Counselor, Mental Health (Licence: CA 89134) | |
| Enumeration Date | 2015-01-12 |
| Last Update Date | 2023-10-30 |