| NPI | 1821342056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 109824) |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YM0800X Counselor, Mental Health (Licence: CA 90062) | |
| 104100000X Social Worker (Licence: CA 90062) | |
| Enumeration Date | 2012-11-09 |
| Last Update Date | 2023-01-09 |