| NPI | 1871955039 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 101358) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA ASW70240) |
| Enumeration Date | 2016-03-25 |
| Last Update Date | 2021-09-14 |