| NPI | 1598163891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 81275) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 36553) |
| Enumeration Date | 2014-12-18 |
| Last Update Date | 2022-08-08 |