| NPI | 1689833113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 108983) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 94742) |
| Enumeration Date | 2008-06-09 |
| Last Update Date | 2024-07-10 |