| NPI | 1922259282 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: CA 27608) |
| Additional Taxonomies | 101Y00000X Counselor |
| 1041C0700X Social Worker, Clinical (Licence: CA 27608) | |
| Enumeration Date | 2008-10-06 |
| Last Update Date | 2015-06-15 |