| NPI | 1780091124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW108890) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA ASW72391) |
| Enumeration Date | 2014-07-17 |
| Last Update Date | 2026-04-15 |