| NPI | 1841590064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CA LCSW72959) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: CA 28976) |
| 101YM0800X Counselor Mental Health (Licence: CA ASW28967) | |
| Enumeration Date | 2010-10-22 |
| Last Update Date | 2016-09-09 |