| NPI | 1700208477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 76151) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 090371) |
| 101YM0800X Counselor, Mental Health | |
| 104100000X Social Worker (Licence: CA ASW66116) | |
| 101Y00000X Counselor (Licence: CA ASW66116) | |
| Enumeration Date | 2014-01-14 |
| Last Update Date | 2017-03-22 |