| NPI | 1841643954 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 87980) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA ASW73109) |
| Enumeration Date | 2016-07-14 |
| Last Update Date | 2020-06-15 |