| NPI | 1689277469 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: CA 97574) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CA 97574) |
| 101YM0800X Counselor, Mental Health (Licence: CA 97574) | |
| 1041C0700X Social Worker, Clinical (Licence: CA 97574) | |
| Enumeration Date | 2020-11-16 |
| Last Update Date | 2024-04-05 |