| NPI | 1871079665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CA LCSW121455) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: CA 104512) |
| 104100000X Social Worker (Licence: CA 104512) | |
| Enumeration Date | 2018-07-14 |
| Last Update Date | 2024-03-20 |