| NPI | 1689077182 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 122069) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CA 103771) |
| 101YM0800X Counselor, Mental Health | |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2014-09-29 |
| Last Update Date | 2026-08-25 |