| NPI | 1568514859 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CA 91580) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 1041C0700X Social Worker Clinical (Licence: CA ASW65109) | |
| Enumeration Date | 2007-01-17 |
| Last Update Date | 2023-10-09 |