| NPI | 1700068319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CA 102046) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: CA 73097) |
| Enumeration Date | 2007-12-05 |
| Last Update Date | 2021-11-02 |