| NPI | 1659757805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 110770) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA ASW91651) |
| Enumeration Date | 2015-08-10 |
| Last Update Date | 2023-03-16 |