| NPI | 1518493816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 114726) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CA ASW71785) |
| 101Y00000X Counselor | |
| Enumeration Date | 2017-05-05 |
| Last Update Date | 2023-04-11 |