| NPI | 1558570796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CA 69465) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 101YP1600X Counselor Pastoral | |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2022-12-09 |