| NPI | 1952748378 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 62081) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 36024) |
| Enumeration Date | 2013-05-24 |
| Last Update Date | 2021-07-12 |