| NPI | 1821221250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 82504) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NM M-08172) |
| Enumeration Date | 2009-09-02 |
| Last Update Date | 2018-05-22 |