| NPI | 1922668508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: CA 103366) |
| 101YM0800X Counselor Mental Health | |
| 104100000X Social Worker | |
| Enumeration Date | 2019-06-17 |
| Last Update Date | 2024-09-10 |