| NPI | 1477960284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 112256) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 83719) |
| 104100000X Social Worker (Licence: CA 83719) | |
| Enumeration Date | 2014-07-14 |
| Last Update Date | 2026-07-20 |