| NPI | 1619412178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW137760) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CA ASW71423) |
| 101YM0800X Counselor, Mental Health (Licence: CA ASW71423) | |
| 1041C0700X Social Worker, Clinical (Licence: CA ASW108644) | |
| 101YM0800X Counselor, Mental Health (Licence: CA ASW108644) | |
| Enumeration Date | 2016-12-19 |
| Last Update Date | 2026-04-21 |