| NPI | 1720305121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OR L6933) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CA 27163) |
| 101YM0800X Counselor, Mental Health (Licence: CA 27163) | |
| 1041C0700X Social Worker, Clinical (Licence: CA 29596) | |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2010-04-23 |
| Last Update Date | 2016-04-15 |