| NPI | 1649781501 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: CA 97266) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: CA 77619) |
| 1041C0700X Social Worker Clinical (Licence: CA LCSW97266) | |
| Enumeration Date | 2017-10-18 |
| Last Update Date | 2023-05-17 |