| NPI | 1710464011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CA 100896) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: CA 84515) |
| 104100000X Social Worker | |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2018-07-19 |
| Last Update Date | 2021-09-13 |