| NPI | 1700012481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: CA LCSW94940) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 1041C0700X Social Worker, Clinical (Licence: CA 94940) | |
| 225400000X Rehabilitation Practitioner | |
| Enumeration Date | 2009-06-08 |
| Last Update Date | 2023-09-15 |