| NPI | 1487177820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 99037) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 79002) |
| 104100000X Social Worker (Licence: CA 79002) | |
| Enumeration Date | 2017-07-18 |
| Last Update Date | 2022-07-21 |