| NPI | 1811445067 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 69011) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| 101YP2500X Counselor, Professional (Licence: CA 69011) | |
| Enumeration Date | 2016-09-16 |
| Last Update Date | 2017-01-25 |