| NPI | 1497151401 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 64631) |
| Enumeration Date | 2014-11-18 |
| Last Update Date | 2018-06-13 |