| NPI | 1740615178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW85804) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA ASW68118) |
| 104100000X Social Worker | |
| Enumeration Date | 2013-09-04 |
| Last Update Date | 2021-07-30 |