| NPI | 1891455663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA ASW105182) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CA ASW105182) |
| Enumeration Date | 2021-12-21 |
| Last Update Date | 2023-10-10 |