| NPI | 1710478060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW100464) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CA ASW85095) |
| Enumeration Date | 2018-05-22 |
| Last Update Date | 2022-02-04 |