| NPI | 1871126086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 93217) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA ASW93217) |
| 104100000X Social Worker (Licence: CA 167029) | |
| Enumeration Date | 2020-02-16 |
| Last Update Date | 2022-10-26 |