| NPI | 1801313838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 110154) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 83794) |
| 101Y00000X Counselor | |
| Enumeration Date | 2017-08-30 |
| Last Update Date | 2025-10-02 |