| NPI | 1952709719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 80798) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 101YM0800X Counselor, Mental Health | |
| 225400000X Rehabilitation Practitioner | |
| Enumeration Date | 2014-12-10 |
| Last Update Date | 2018-12-21 |