| NPI | 1609330778 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 125913) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CA 102074) |
| 101YM0800X Counselor, Mental Health (Licence: CA 102074) | |
| Enumeration Date | 2019-01-23 |
| Last Update Date | 2024-09-17 |