| NPI | 1710252754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 75000) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CA 75000) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA S1301291433) | |
| 101YM0800X Counselor, Mental Health (Licence: CA 107860) | |
| 1041C0700X Social Worker, Clinical (Licence: CA 107860) | |
| 1041S0200X Social Worker, School (Licence: CA 190270138) | |
| Enumeration Date | 2012-03-08 |
| Last Update Date | 2022-05-25 |