| NPI | 1801046693 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW27445) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA ASW24941) |
| 104100000X Social Worker (Licence: CA LCS27445) | |
| Enumeration Date | 2008-09-29 |
| Last Update Date | 2016-06-24 |