| NPI | 1477115970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 1041C0700X Social Worker Clinical (Licence: CA 126085) | |
| Enumeration Date | 2019-07-03 |
| Last Update Date | 2024-10-23 |