| NPI | 1750706768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 81748) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CA 32210) |
| 101YM0800X Counselor, Mental Health (Licence: CA 32210) | |
| Enumeration Date | 2014-02-27 |
| Last Update Date | 2019-02-20 |