| NPI | 1467980367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: CA 117647) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 104100000X Social Worker (Licence: CA 86192) | |
| 1041C0700X Social Worker, Clinical (Licence: CA 86192) | |
| Enumeration Date | 2017-05-23 |
| Last Update Date | 2023-09-15 |