| NPI | 1578604815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW28515) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA ASW 14603) |
| Enumeration Date | 2007-02-09 |
| Last Update Date | 2016-02-16 |