| NPI | 1831643030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CA 98274) |
| Additional Taxonomies | 101YP2500X Counselor Professional |
| Enumeration Date | 2016-08-05 |
| Last Update Date | 2025-06-23 |