| NPI | 1952895229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW107751) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA ACSW84071) |
| Enumeration Date | 2018-06-19 |
| Last Update Date | 2022-05-04 |