| NPI | 1699256354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW111084) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA ASW89800) |
| 101YM0800X Counselor, Mental Health (Licence: CA ASW89800) | |
| Enumeration Date | 2018-08-21 |
| Last Update Date | 2023-10-02 |