| NPI | 1952775728 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 95624) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CA ASW67238) |
| 101YM0800X Counselor, Mental Health (Licence: CA IMF67238) | |
| 1041C0700X Social Worker, Clinical (Licence: CA ASW67238) | |
| Enumeration Date | 2015-11-17 |
| Last Update Date | 2021-04-19 |