| NPI | 1740820034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 141663) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CA 112862) |
| 101Y00000X Counselor (Licence: CA 112862) | |
| Enumeration Date | 2020-01-14 |
| Last Update Date | 2026-08-24 |