| NPI | 1689343121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 126320) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CA ACSW104543) |
| Enumeration Date | 2021-09-08 |
| Last Update Date | 2024-10-01 |