| NPI | 1740613306 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 92529) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2013-08-17 |
| Last Update Date | 2023-07-31 |