| NPI | 1780726737 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CA 84075) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: CA ACSW 19879) |
| 101YM0800X Counselor Mental Health (Licence: CA ACSW 19879) | |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2020-07-29 |