| NPI | 1578760914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 65554) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CA 26735) |
| 104100000X Social Worker | |
| 1041C0700X Social Worker, Clinical (Licence: CA 6554) | |
| Enumeration Date | 2007-06-29 |
| Last Update Date | 2024-05-22 |