| NPI | 1578070744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: CA 87485) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 87458) |
| 1041C0700X Social Worker, Clinical (Licence: CA 87946) | |
| Enumeration Date | 2018-01-09 |
| Last Update Date | 2026-03-04 |