| NPI | 1801223995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 1041C0700X Social Worker, Clinical (Licence: CA 60490) | |
| 1041C0700X Social Worker, Clinical (Licence: CA 93734) | |
| Enumeration Date | 2013-10-03 |
| Last Update Date | 2023-07-12 |