| NPI | 1730671868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 133568) |
| Additional Taxonomies | 104100000X Social Worker |
| 104100000X Social Worker (Licence: CA ASW133169) | |
| 101YM0800X Counselor, Mental Health (Licence: CA asw133169) | |
| 101Y00000X Counselor | |
| Enumeration Date | 2018-06-04 |
| Last Update Date | 2025-09-16 |