| NPI | 1487937330 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CA 75520) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: CA ASW 37133) |
| Enumeration Date | 2011-09-27 |
| Last Update Date | 2018-03-17 |