| NPI | 1548517980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW80442) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA ASW 34403) |
| 101YM0800X Counselor, Mental Health (Licence: CA LCSW80442) | |
| Enumeration Date | 2012-08-03 |
| Last Update Date | 2019-09-17 |