| NPI | 1528470929 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 120528) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 90534) |
| 171M00000X Case Manager/Care Coordinator (Licence: CA "NA") | |
| 104100000X Social Worker | |
| Enumeration Date | 2014-05-20 |
| Last Update Date | 2024-01-21 |