| NPI | 1710400460 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 108591) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA ASW84482) |
| 104100000X Social Worker | |
| 104100000X Social Worker (Licence: CA 108951) | |
| Enumeration Date | 2017-07-24 |
| Last Update Date | 2025-03-14 |