| NPI | 1952635112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 75206) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA ASW 30406) |
| Enumeration Date | 2009-09-21 |
| Last Update Date | 2018-06-06 |