| NPI | 1922323278 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 118599) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CA 97852) |
| Enumeration Date | 2010-03-30 |
| Last Update Date | 2024-07-03 |