| NPI | 1689844847 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW80920) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 62626) |
| 225400000X Rehabilitation Practitioner | |
| Enumeration Date | 2008-03-04 |
| Last Update Date | 2019-06-26 |