| NPI | 1518453166 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW110641) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 84026) |
| 225400000X Rehabilitation Practitioner | |
| Enumeration Date | 2018-07-06 |
| Last Update Date | 2023-01-06 |