| NPI | 1801317847 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 100864) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 76881) |
| Enumeration Date | 2017-06-29 |
| Last Update Date | 2022-07-21 |