| NPI | 1740510361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 111950) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 37916) |
| Enumeration Date | 2010-01-04 |
| Last Update Date | 2023-05-01 |