| NPI | 1669885380 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW82182) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 66530) |
| 101YM0800X Counselor, Mental Health (Licence: NE 10270) | |
| 1041C0700X Social Worker, Clinical (Licence: CA 66530) | |
| 1041C0700X Social Worker, Clinical (Licence: NE 6926) | |
| Enumeration Date | 2014-06-10 |
| Last Update Date | 2018-09-19 |