| NPI | 1558730473 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 99307) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OR L17748) |
| 101Y00000X Counselor | |
| Enumeration Date | 2015-09-22 |
| Last Update Date | 2026-02-25 |