| NPI | 1912646696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 113359) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 101YM0800X Counselor, Mental Health (Licence: CA 113359) | |
| 101Y00000X Counselor (Licence: CA 113359) | |
| Enumeration Date | 2022-06-01 |
| Last Update Date | 2024-09-11 |