| NPI | 1497326565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 104100000X Social Worker |
| 1041C0700X Social Worker, Clinical (Licence: CA 135550) | |
| Enumeration Date | 2021-07-08 |
| Last Update Date | 2025-12-04 |